| Entity Name: | BERCAW NEUROPSYCHOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Jun 2017 (8 years ago) |
| Document Number: | L17000130802 |
| FEI/EIN Number | 82-1894521 |
| Address: | 1601 Rickenbacker Dr, Sun City Center, FL, 33573, US |
| Mail Address: | 1601 Rickenbacker Dr, Sun City Center, FL, 33573, US |
| ZIP code: | 33573 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134633092 | 2017-11-29 | 2018-04-20 | 710 OAKFIELD DR STE 153, BRANDON, FL, 335114954, US | 710 OAKFIELD DR STE 153, BRANDON, FL, 335114954, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 813-603-7635 |
| Fax | 8135011186 |
Authorized person
| Name | DR. EDWIN BERCAW |
| Role | NEUROPSYCHOLOGIST |
| Phone | 8136037635 |
Taxonomy
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| License Number | PY7991 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY7991 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | FLORIDA BLUE |
| Number | 5932X |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BERCAW EDWIN L | Agent | 5724 114th Dr E, Parrish, FL, 34219 |
| Name | Role | Address |
|---|---|---|
| BERCAW EDWIN L | Authorized Member | 5724 114th Dr E, Parrish, FL, 34219 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-31 | 5724 114th Dr E, Parrish, FL 34219 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-05-12 | 1601 Rickenbacker Dr, STE 3, Sun City Center, FL 33573 | No data |
| CHANGE OF MAILING ADDRESS | 2021-05-12 | 1601 Rickenbacker Dr, STE 3, Sun City Center, FL 33573 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-15 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-06-13 |
| ANNUAL REPORT | 2018-04-27 |
| Florida Limited Liability | 2017-06-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
