MEDICARE: MR. MARK W COLTERJOHN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	070239	NY

General Provider Information

NPI Number	:	1356457642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK W COLTERJOHN LCSW

Provider Business Mailing Address
First Line	:	672 FULTON ST APT 3B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1569
Country	:	US
Telephone Number	:	646-872-5451
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 LEXINGTON AVE STE 300
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-0941
Country	:	US
Telephone Number	:	646-872-5451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	04/25/2025

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