Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 54045 | TX |
NPI | 1003136581 |
---|---|
Provider Name | James Stephen Bercik |
First Address | Austin, TX 78759-3522 |
Second Address | Temple, TX 76504-7451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 07/06/2010 |