Individual provider Active NPI

Charles O'Rourke, LCSW

  • Clinical Social Worker
  • Portland, ME
National Provider Identifier
1831279389
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC11511 Issued in ME
Practice address
22 Monument SQ Ste 401
Portland, ME 04101-4771
Phone
(207) 274-1663
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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 LC11511 ME Primary

Addresses

Primary practice location

22 Monument SQ Ste 401
Portland, ME 04101-4771

Mailing address

22 Monument SQ Ste 401
Portland, ME 04101-4771
Phone (207) 274-1663

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
I20230505001701 ME Practitioner - Clinical Social Worker 7315302890 Practice locations: Portland, ME

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

22 Monument SQ
Suite 401
Portland, ME 04101-4771
Phone (207) 274-1663

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1831279389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 MONUMENT SQ STE 401",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014771",
            "telephone_number": "207-274-1663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 MONUMENT SQ STE 401",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014771",
            "telephone_number": "207-274-1663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'ROURKE",
        "first_name": "CHARLES",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC11511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.