Individual
PETER RALPH BOURQUE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, APRN, PMHNP-BC
Contact information
Practice address
1650 SYCAMORE AVE STE 39, BOHEMIA, NY 11716-1736
(631) 213-1770
(631) 315-8042
Mailing address
1650 SYCAMORE AVE STE 39, BOHEMIA, NY 11716-1736
(631) 213-1770
(631) 315-8042
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
525838
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
5047
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F402626
NY
Other
Enumeration date
09/13/2012
Last updated
01/31/2026
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