Healthcare Provider Details

I. General information

NPI: 1568469807
Provider Name (Legal Business Name): MARK CHATKIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 34TH ST PENTHOUSE
NEW YORK NY
10001-3006
US

IV. Provider business mailing address

9 CHARDONNAY RD
CORTLANDT MANOR NY
10567-5131
US

V. Phone/Fax

Practice location:
  • Phone: 914-523-4619
  • Fax: 914-788-0074
Mailing address:
  • Phone: 914-523-4619
  • Fax: 914-788-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR027769
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR027769
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: