Provider Demographics
NPI:1447380837
Name:OROURKE, DANIEL (MFT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:OROURKE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:OROURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:4452 PARK BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4049
Mailing Address - Country:US
Mailing Address - Phone:619-297-3332
Mailing Address - Fax:619-297-6701
Practice Address - Street 1:4452 PARK BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4049
Practice Address - Country:US
Practice Address - Phone:619-297-3332
Practice Address - Fax:619-297-6701
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist