Provider Demographics
NPI:1093852782
Name:O'ROURKE, CHRISTOPHER G (LICSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:G
Last Name:O'ROURKE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 S HUNTINGTON AVE
Mailing Address - Street 2:UNIT #12A
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4809
Mailing Address - Country:US
Mailing Address - Phone:617-817-3977
Mailing Address - Fax:
Practice Address - Street 1:185 BAY STATE RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1506
Practice Address - Country:US
Practice Address - Phone:617-353-3047
Practice Address - Fax:617-353-5539
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10293221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical