| Kathryn A.bourke, Psy. D., Inc. | |
|
436 W 20th St Merced CA 95340-3714 | |
| (209) 384-8808 | |
| Not Available |
| Full Name | Kathryn A.bourke, Psy. D., Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 436 W 20th St, Merced, California |
| Authorized Official Name and Position | Kathryn A. Bourke (OWNER/PRESIDENT) |
| Authorized Official Contact | 2093848808 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathryn A.bourke, Psy. D., Inc. Po Box 2743 Merced CA 95344-0743 Ph: (209) 384-8808 | Kathryn A.bourke, Psy. D., Inc. 436 W 20th St Merced CA 95340-3714 Ph: (209) 384-8808 |
| NPI Number | 1558661041 |
|---|---|
| Provider Enumeration Date | 10/30/2010 |
| Last Update Date | 03/23/2011 |
| Medicare PECOS PAC ID | 8224202320 |
|---|---|
| Medicare Enrollment ID | O20111130000405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558661041 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY 16571 (California) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | PSY 16571 (California) | Secondary |
| Provider Name | Kathryn A Bourke |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477634673 PECOS PAC ID: 0345231544 Enrollment ID: I20040518000974 |
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