Provider Demographics
NPI:1144850744
Name:JOHN M BERECZ PHD ABPP LLC
Entity type:Organization
Organization Name:JOHN M BERECZ PHD ABPP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK/BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-921-4921
Mailing Address - Street 1:2117 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-9367
Mailing Address - Country:US
Mailing Address - Phone:269-470-9999
Mailing Address - Fax:
Practice Address - Street 1:2117 GRANGE RD
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107-9367
Practice Address - Country:US
Practice Address - Phone:269-470-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty