1548326143 NPI number — MS. JOSETTE O'ROURKE MSW, LCSW

Table of content: MS. JOSETTE O'ROURKE MSW, LCSW (NPI 1548326143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548326143 NPI number — MS. JOSETTE O'ROURKE MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'ROURKE
Provider First Name:
JOSETTE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEMICHAEL
Provider Other First Name:
JOSETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548326143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 POWERVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOONTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07005-8705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-299-5456
Provider Business Mailing Address Fax Number:
973-316-1839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ROUTE 46 WEST
Provider Second Line Business Practice Location Address:
VILLAGE GREEN
Provider Business Practice Location Address City Name:
BUDD LAKE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-347-4300
Provider Business Practice Location Address Fax Number:
973-347-0984
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC04767900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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