Provider Demographics
NPI:1386733392
Name:ROURKE, MARY T (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:T
Last Name:ROURKE
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Gender:F
Credentials:PHD
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Mailing Address - Street 1:3440 MARKET ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3325
Mailing Address - Country:US
Mailing Address - Phone:215-590-7532
Mailing Address - Fax:215-590-4251
Practice Address - Street 1:34TH STREET & CIVIC CENTER BLVD
Practice Address - Street 2:ONCOLOGY CLINIC
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-7555
Practice Address - Fax:215-590-7387
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAPS009083L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist