Provider Demographics
NPI:1437300399
Name:BOURKE, BRENDAN STEPHEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:STEPHEN
Last Name:BOURKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 FOOTHILLS DR
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-7948
Mailing Address - Country:US
Mailing Address - Phone:970-599-1639
Mailing Address - Fax:
Practice Address - Street 1:4437 FOOTHILLS DR
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-7948
Practice Address - Country:US
Practice Address - Phone:907-599-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099274221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical