Provider Demographics
NPI:1235541830
Name:O'ROURKE, LAUREN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:M
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 1:70 SOUTHWOODS RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3204
Mailing Address - Country:US
Mailing Address - Phone:631-392-6604
Mailing Address - Fax:
Practice Address - Street 1:3815 WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3745
Practice Address - Country:US
Practice Address - Phone:617-983-5800
Practice Address - Fax:617-983-5854
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0868131041C0700X
NY1041S0200X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool