Peter Ralph Bourque Jr., MS, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F402626 Issued in NY

Practice address

1650 Sycamore Ave Ste 39
Bohemia, NY 11716-1736

Phone

(631) 213-1770

Fax

(631) 315-8042

NPI assigned

Sep 13, 2012

Sex

Male

Sole proprietor

Yes

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.

• Peter Bourque NP LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bohemia, NY
  • NPI 1629810585
  NPD ADULT HEALTH
• Gandara Mental Health Center Inc

  • Mental Health Counselor
  • Springfield, MA
  • NPI 1134107113
  NPD

• Peter R Bourque Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 31, 2026.

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769817600000",
    "number": "1972853299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 SYCAMORE AVE STE 39",
            "city": "BOHEMIA",
            "state": "NY",
            "postal_code": "117161736",
            "telephone_number": "631-213-1770",
            "fax_number": "631-315-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 SYCAMORE AVE STE 39",
            "city": "BOHEMIA",
            "state": "NY",
            "postal_code": "117161736",
            "telephone_number": "631-213-1770",
            "fax_number": "631-315-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURQUE",
        "first_name": "PETER",
        "middle_name": "RALPH",
        "name_suffix": "Jr.",
        "credential": "MS, APRN, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-13",
        "last_updated": "2026-01-31",
        "certification_date": "2026-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "525838",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PETER",
            "last_name": "BOURQUE",
            "middle_name": "R",
            "credential": "MS, APRN, PMHNP-BC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Christine Bode, MASTERS DEGREE EDU
• Suzanne Marie Bogdanowich, LMT
• Bohemia Dental Arts
• Joy Marie Bolger, M.S. LMHC
• Brenda Bottigliere
• Amy Bouziotis, MHC
• Nancy Lynn Bowden, NP, CNM
• Jessica Breitweg, PHARMD, RPH
• Bright Bay Medical PLLC
• Brookview Medical Associates, PLLC

• All providers in Bohemia, NY
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.