IndividualActive
Kyle Bourque, LISW
NPI 1124018650 · Social Worker · Fort Drum, NY
Kyle Bourque, LISW is a Social Worker provider in Fort Drum, NY (NPI 1124018650).
Provider details
- NPI number
- 1124018650
- Entity type
- Individual
- Primary specialty
- Social WorkerBehavioral Health & Social Service Providers
- Credential
- LISW
- Sex
- Male
- Sole proprietor
- No
- License
- 04825 (IA)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
USA Meddac Attn: Credentials
11050 Mt Belvedere Blvd
Fort Drum, NY 13602-5004
Phone: (315) 772-4025
Fax: (315) 772-9498
Approximate (ZIP-level) locationGet directions
Mailing address
USA Meddac
Fort Drum, NY 13602
Registry dates
- Enumerated
- 2005-10-26
- Last updated
- 2022-01-24
- Certified
- 2022-01-18
Frequently asked questions
- What is Kyle Bourque's NPI number?
- Kyle Bourque's National Provider Identifier (NPI) is 1124018650, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Kyle Bourque's specialty?
- Kyle Bourque is listed in the NPPES registry with a primary specialty of Social Worker (Behavioral Health & Social Service Providers).
- Where is Kyle Bourque located?
- Kyle Bourque's practice location on file with NPPES is USA Meddac Attn: Credentials, Fort Drum, NY 13602-5004.
- What is Kyle Bourque's phone number?
- The practice phone number listed in the NPPES registry for Kyle Bourque is (315) 772-4025.
- Is Kyle Bourque's NPI active?
- Yes — Kyle Bourque's NPI (1124018650) is active in the NPPES registry as of the last update on 2022-01-24.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.