Provider Demographics
NPI:1710397237
Name:ROURKE-DUFFY, MARY KALEAN (MSS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KALEAN
Last Name:ROURKE-DUFFY
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 E TEXAS RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-9357
Mailing Address - Country:US
Mailing Address - Phone:484-866-1361
Mailing Address - Fax:
Practice Address - Street 1:4235 E TEXAS RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-9357
Practice Address - Country:US
Practice Address - Phone:484-866-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH0016781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical