Provider Demographics
NPI:1396546479
Name:BOURK, MORIAH ELIZABETH (MS, LBS)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:ELIZABETH
Last Name:BOURK
Suffix:
Gender:F
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GREEN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1752
Mailing Address - Country:US
Mailing Address - Phone:401-663-7128
Mailing Address - Fax:
Practice Address - Street 1:230 GREEN ST APT 6
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1752
Practice Address - Country:US
Practice Address - Phone:401-663-7128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH007638103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst