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NPI Code Detail

MEDICARE: ANDREW B. BOURKE PH.D.

MEDICARE: ANDREW B. BOURKE PH.D.
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
1103T00000XPsychologist7697MA

General Provider Information

NPI Number : 1265486153
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW B. BOURKE PH.D.
Provider Business Mailing Address
First Line : 17 HUBBARD AVE
Second Line :
City : NORTHAMPTON
State : MA
Zip : 01060-1823
Country : US
Telephone Number : 413-297-0970
Fax Number : 413-585-8210
Provider Business Practice Location Address
First Line : 16 ARMORY ST
Second Line : 25
City : NORTHAMPTON
State : MA
Zip : 01060-3857
Country : US
Telephone Number : 413-585-8211
Fax Number : 413-585-8210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2006
Last Update Date : 07/09/2007

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