| Doctor Name: | MARY ANN ROURKE |
| NPI Number: | 1023139391 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 004665 |
| Business Practice Address: | 95 Scovill St 3rd Floor Waterbury, CT - 067061113 |
| Business Phone Number: | 2037097081 |
| Business Fax Number: | 2037097754 |
| Mailing Address: | 56 Franklin St, 3rd Floor WATERBURY |
| State: | CT |
| Postal Code: | 067061221 |
| Phone Number: | 2037098873 |
| Fax Number: | 2037098689 |
| NPI Enumeration Date: | 04/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 004665 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |