Healthcare Provider Details

I. General information

NPI: 1063455269
Provider Name (Legal Business Name): JOSEPH CHARLES O'ROURKE LCSW, BCD, CTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 EXTON COMMONS EDGETTE & ASSOCIATES
EXTON PA
19341
US

IV. Provider business mailing address

118 AUTUMN TRL
COATESVILLE PA
19320-2096
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-8717
  • Fax:
Mailing address:
  • Phone: 484-712-5036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015202
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: