Healthcare Provider Details

I. General information

NPI: 1073754206
Provider Name (Legal Business Name): PAUL JOSEPH O'ROURKE M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N EASTON RD
GLENSIDE PA
19038-4301
US

IV. Provider business mailing address

614 N EASTON RD
GLENSIDE PA
19038-4301
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-9770
  • Fax: 215-884-6301
Mailing address:
  • Phone: 215-884-9770
  • Fax: 215-884-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: