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MR. KYLE P BOURQUE LISW
NPI 1124018650
Social Worker in Fort Drum, NY

Active since October 26, 2005
USA MEDDAC ATTN: CREDENTIALS, 11050 MT BELVEDERE BLVD, FORT DRUM, NY 13602(315) 772-4025(315) 772-9498 Get Directions Write a Review

NPPES record last updated: January 24, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Kyle P Bourque Lisw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KYLE P BOURQUE LISW (NPI 1124018650) is an individual social worker in Fort Drum, New York, licensed in Iowa (04825) and active in the NPI registry since October 2005.

NPPES Registry Identity

NPI1124018650
Entity TypeIndividualMale
Primary Taxonomy104100000X
Provider Legal NameMR. KYLE P BOURQUECredential: LISW
Location AddressUSA MEDDAC ATTN: CREDENTIALS, 11050 MT BELVEDERE BLVDFort Drum, NY 13602-5004
Mailing AddressUsa Meddac, 11050 Mt Belvedere BlvdFort Drum, NY 13602 · (315) 772-4025 · Fax (315) 772-9498
Phone(315) 772-4025
Fax(315) 772-9498
Sole ProprietorNo
Enumeration DateOctober 26, 2005
Last NPPES UpdateJanuary 24, 2022
NPPES CertifiedJanuary 18, 2022
✔ NPI 1124018650 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
License✔ Licensed in IA · 04825
Definition
A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
USA MEDDAC ATTN: CREDENTIALS, Fort Drum, NY 13602
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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. ROGER DUANE EAKS LCSW
Social Worker
USA MEDDAC ATTN: CREDENTIALS, 11050 MT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-4025
HEIDI L BOERMAN PA-C, ATC
Physician Assistant
USA MEDDAC ATTN: CREDENTIALS, 11050 MT BELVEDERE BLVD
FORT DRUM, NY 13602
Jefferson County (315) 772-4025

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kyle Bourque's NPI number?

The NPI number for Kyle Bourque is 1124018650. It was assigned to this individual provider in the NPPES registry on October 26, 2005.

Where is Kyle Bourque located?

Kyle Bourque practices at Usa Meddac Attn: Credentials 11050 Mt Belvedere Blvd, Fort Drum, NY 13602. The listed phone number is (315) 772-4025.

What is Kyle Bourque's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

When was this NPI record last updated?

The NPPES record for Kyle Bourque was last updated on January 24, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.