Jaime Bercuson, M.A., PSY.D.
Individual provider Active NPI Clinical Psychologist · Park City, UT
NPI 1932332012 · NPPES record last updated Nov 10, 2020
Key facts
- NPI
- 1932332012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 10389140-2501 (UT)
- Practice address
- 1389 Center Dr Ste 200
Park City, UT 84098-7660 - Phone
- (727) 451-9223
- NPI assigned
- Aug 24, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY26093 | CA | MD | Clinical Psychologist |
| 10389140-2501 | UT | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY26093 | CA | |
| Clinical Psychologist | 103TC0700X | PY8969 | FL | |
| Clinical Psychologist | 103TC0700X | 10389140-2501 | UT | Yes |
Addresses
Primary practice location
1389 Center Dr Ste 200
Park City, UT 84098-7660
Mailing address
1389 Center Dr Ste 200
Park City, UT 84098-7660
Phone (727) 451-9223
Other providers in Park City, UT
- Beehive Homes of Park City
- Elise Amelia Begg
- Ellen Behrens
- Marlo Kathleen Bennett
- Aaron Bennion
- Joseph H Berman
- Nichole Bernhard
- Cynthia C Berwald
- Kirstyn Besch
- Jennifer Bevilacqua
All providers in Park City, UT · Clinical Psychologist in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.