MEDICARE: MS. KRISTINE D. O'ROURKE L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1180	LA

General Provider Information

NPI Number	:	1033239371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINE D. O'ROURKE L.C.S.W.

Provider Business Mailing Address
First Line	:	518 LEONTINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-1919
Country	:	US
Telephone Number	:	504-897-0498
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 LEONTINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-1919
Country	:	US
Telephone Number	:	504-897-0498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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