Provider Demographics
NPI:1104972546
Name:BERCUN, BRENDA MERYL SIEGEL
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:MERYL SIEGEL
Last Name:BERCUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORTE DEL CORONADO
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1503
Mailing Address - Country:US
Mailing Address - Phone:415-927-4839
Mailing Address - Fax:415-927-4839
Practice Address - Street 1:2180 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-3405
Practice Address - Country:US
Practice Address - Phone:415-346-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338251163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health