Provider Demographics
NPI:1497113641
Name:O'ROURKE, KRISTYN (LCSW, CAADC)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:LCSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2526
Mailing Address - Country:US
Mailing Address - Phone:607-368-3647
Mailing Address - Fax:
Practice Address - Street 1:100 HENRY ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2909
Practice Address - Country:US
Practice Address - Phone:570-731-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0207421041C0700X
NY097079101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)