Provider Demographics
NPI:1629315197
Name:O'ROURKE, JENNIFER LAUREN (MHC, CASACT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LAUREN
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:MHC, CASACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6583 160TH ST APT 1J
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2515
Mailing Address - Country:US
Mailing Address - Phone:347-515-1180
Mailing Address - Fax:
Practice Address - Street 1:6207 WOODSIDE AVE 4TH FLOOR
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:718-898-5085
Practice Address - Fax:718-898-5582
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)