Active NPI
Kelly B Rourke, ASW
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1487145462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 96746
- Practice address
- 3517 Camino del Rio S Ste 407
San Diego, CA 92108-4028 - Phone
- (619) 955-8905
- NPI assigned
- May 24, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Clinical Social Worker | 1041C0700X | 96746 | CA | Primary |
Addresses
Primary practice location
3517 Camino del Rio S Ste 407
San Diego, CA 92108-4028
Mailing address
3517 Camino del Rio S Ste 407
San Diego, CA 92108-4028
Phone (619) 955-8905
Other practice location 1
2000 Fordem Ave
Madison, WI 53704
Phone (608) 280-2740
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 907812514400 | Other | WI | THE ALLIANCE FIRST HEALTH NETWORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 96746 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1487145462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3517 CAMINO DEL RIO S STE 407",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921084028",
"telephone_number": "619-955-8905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3517 CAMINO DEL RIO S STE 407",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921084028",
"telephone_number": "619-955-8905"
}
],
"practiceLocations": [
{
"address_1": "2000 Fordem Ave",
"address_purpose": "LOCATION",
"city": "Madison",
"state": "WI",
"postal_code": "53704",
"country_code": "US",
"telephone_number": "608-280-2740",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROURKE",
"first_name": "KELLY",
"middle_name": "B",
"credential": "ASW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-24",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "96746",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THE ALLIANCE FIRST HEALTH NETWORK",
"identifier": "907812514400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.