Peter Ralph Bourque Jr., PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F402626-01 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

Last updated

Nov 2, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Peter Bourque NP LLC

  dba Peter Bourque NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bohemia, NY
  • NPI 1629810585

  Adult Health

  NPD Authorized official
• Gandara Mental Health Center Inc

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

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

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1793577600000",
    "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": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-13",
        "last_updated": "2026-11-02",
        "certification_date": "2026-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402626-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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

• Psychiatric/Mental Health Nurse Practitioner in Bohemia, NY
• Providers in Bohemia, NY by specialty
• 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 Nov 2, 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.