Basic Information
| Provider Information | |||||||||
| NPI: | 1538547781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'ROURKE | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2756 POST RD | ||||||||
| Address2: | |||||||||
| City: | WARWICH | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017381338 | ||||||||
| FaxNumber: | 4017395239 | ||||||||
| Practice Location | |||||||||
| Address1: | 2756 POST RD | ||||||||
| Address2: | |||||||||
| City: | WARWICH | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017381338 | ||||||||
| FaxNumber: | 4017395239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2015 | ||||||||
| LastUpdateDate: | 05/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDP00612 | RI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | RI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | CDP00612 | 01 | RI | LISCENSE | OTHER |