Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Kyle P Bourque, LISW

Individual provider Social Worker · NPI 1124018650

Mr. Kyle P Bourque, LISW is a Social Worker in Fort Drum, New York. Licensed in Iowa. Registered with an NPI since 2005.

Licensed in
IA
In the registry since
2005
What do these letters mean?
LISW — Licensed Independent Social Worker
A social worker licensed to practise independently.

See every abbreviation used in this directory →

Practice location Partly verified

Some contact details are missing from the federal record.

USA Meddac Attn: Credentials 11050 Mt Belvedere Blvd
Fort Drum, NY 13602-5004
Phone: (315) 772-4025
Fax: (315) 772-9498
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence 04825 (IA)

Record details

NPI number1124018650
Entity typeIndividual (Type 1)
GenderMale
Credentials LISW
Sole proprietorNo
NPI enumeratedOctober 26, 2005
Last updated in NPPESJanuary 24, 2022
Certification dateJanuary 18, 2022
Mailing addressUsa Meddac, 11050 Mt Belvedere Blvd, Fort Drum, NY 13602

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