Individual provider · Type 1 NPI

Peter Ralph Bourque Jr., PMHNP-BC

Psychiatric/Mental Health Nurse Practitioner · Bohemia, NY

NPI number 1972853299 Active

Practice location

1650 Sycamore Ave Ste 39
Bohemia, NY 11716-1736

Fax (631) 315-8042

Specialties and licenses

TaxonomyCodeLicense
Psychiatric/Mental Health Nurse Practitioner Primary 363LP0808XF402626-01 (NY)

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

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About NPI 1972853299

Peter Ralph Bourque Jr., PMHNP-BC's National Provider Identifier is 1972853299, issued on Sep 13, 2012. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Bohemia, NY. The record was last updated on Nov 2, 2026.