Provider Demographics
NPI:1568567261
Name:O'ROURKE, JAMES K (PSYD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:O'ROURKE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ARROW ST
Mailing Address - Street 2:STE 210
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5105
Mailing Address - Country:US
Mailing Address - Phone:617-491-1661
Mailing Address - Fax:
Practice Address - Street 1:12 ARROW ST
Practice Address - Street 2:STE 210
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5105
Practice Address - Country:US
Practice Address - Phone:617-491-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8128103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51174Medicare ID - Type Unspecified