Provider Demographics
NPI:1538452578
Name:ROURKE, REBECCA (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROURKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9370
Mailing Address - Country:US
Mailing Address - Phone:802-362-0994
Mailing Address - Fax:802-362-1867
Practice Address - Street 1:113 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9370
Practice Address - Country:US
Practice Address - Phone:802-362-0994
Practice Address - Fax:802-362-1867
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480067579103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical