Provider Demographics
NPI:1477855658
Name:BOURKE, CYNDY (APRN/PMH)
Entity Type:Individual
Prefix:MS
First Name:CYNDY
Middle Name:
Last Name:BOURKE
Suffix:
Gender:F
Credentials:APRN/PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114A WEST WATER STREET
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617
Mailing Address - Country:US
Mailing Address - Phone:410-758-3008
Mailing Address - Fax:410-758-3008
Practice Address - Street 1:114 W WATER ST STE A
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1060
Practice Address - Country:US
Practice Address - Phone:410-758-3008
Practice Address - Fax:410-758-3008
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD#R175635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health