Provider Demographics
NPI:1679182521
Name:O'ROURKE, BRETTA (BS, MS, CLC)
Entity Type:Individual
Prefix:MRS
First Name:BRETTA
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:BS, MS, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 GRANT PL APT 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5471
Mailing Address - Country:US
Mailing Address - Phone:740-541-7244
Mailing Address - Fax:
Practice Address - Street 1:2016 GRANT PL APT 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5471
Practice Address - Country:US
Practice Address - Phone:740-541-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No174N00000XOther Service ProvidersLactation Consultant, Non-RN