Individual provider Active NPI

Bridget O'Rourke, LCSW

  • Clinical Social Worker
  • Waterville, ME
National Provider Identifier
1558764019
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC15864 Issued in ME
Practice address
67 Eustis Pkwy
Waterville, ME 04901
Phone
(207) 873-2136
Fax
(207) 660-4529
NPI assigned
Sep 29, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC15864 ME Primary

Addresses

Primary practice location

67 Eustis Pkwy
Waterville, ME 04901

Mailing address

127 Palmer St
Calais, ME 04619-1300
Phone (207) 454-0270

Other identifiers 1

IdentifierTypeStateIssuer
1558764019MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160408001194 ME Practitioner - Clinical Social Worker 0143528034 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kennebec Valley Mental Health CenterGroup PAC ID 7113829383, 68 clinicians

Practice addresses (Care Compare)

67 Eustis Pkwy
Waterville, ME 04901-5173
Phone (207) 873-2136

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kennebec Valley Mental Health Center CurrentSince Jul 16, 2018 Accepting new patients

Locations

66 Stone St
Augusta, ME 04330
Phone (207) 626-3455

10 Caldwell Rd
Augusta, ME 04330
Phone (207) 626-3448

115 Mt Blue Cir
Farmington, ME 04938
Phone (207) 778-9664

5 Commerce Dr
Skowhegan, ME 04976
Phone (207) 474-8311

67 Eustis Pkwy
Waterville, ME 04901
Phone (207) 660-4549

736 Old Lewiston Rd
Winthrop, ME 04364
Phone (207) 377-8122

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1558764019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 PALMER ST",
            "city": "CALAIS",
            "state": "ME",
            "postal_code": "046191300",
            "telephone_number": "207-454-0270",
            "fax_number": "207-454-0232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 EUSTIS PKWY",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "04901",
            "telephone_number": "207-873-2136",
            "fax_number": "207-660-4529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'ROURKE",
        "first_name": "BRIDGET",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-29",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC15864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558764019",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterville, ME

Sources for this page

Verify at the official NPI Registry.