Provider Demographics
NPI:1083915292
Name:O'ROURKE, KERRI ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:ANN
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 EXECUTIVE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1707
Mailing Address - Country:US
Mailing Address - Phone:516-858-2877
Mailing Address - Fax:
Practice Address - Street 1:255 EXECUTIVE DR STE 110
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1707
Practice Address - Country:US
Practice Address - Phone:516-858-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0757711041S0200X
NY0757711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool