Provider Demographics
NPI:1891386918
Name:O'ROURKE, AMY-LEIGH MELISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY-LEIGH
Middle Name:MELISSA
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 BIRCH PKWY
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2831
Mailing Address - Country:US
Mailing Address - Phone:201-446-5760
Mailing Address - Fax:
Practice Address - Street 1:22-08 NJ-208
Practice Address - Street 2:SUITE 2
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410
Practice Address - Country:US
Practice Address - Phone:201-583-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06598400104100000X
NJ44SC062766001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker