MEDICARE: MR. MARK CHATKIN 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	R027769	NY
2	104100000X	Social Worker	R027769	NY
3	1041S0200X	School Social Worker		NY

General Provider Information

NPI Number	:	1568469807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK CHATKIN LCSW

Provider Business Mailing Address
First Line	:	9 CHARDONNAY RD
Second Line	:
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-5131
Country	:	US
Telephone Number	:	914-523-4619
Fax Number	:	914-788-0074

Provider Business Practice Location Address
First Line	:	19 W 34TH ST
Second Line	:	PENTHOUSE
City	:	NEW YORK
State	:	NY
Zip	:	10001-3006
Country	:	US
Telephone Number	:	914-523-4619
Fax Number	:	914-788-0074

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	11/10/2014

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