=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760536536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ZEV SOMERSTEIN LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 E 84TH ST 2P
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-772-9465
-----------------------------------------------------
Fax | 212-348-4165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 EAST 84 STREET 2P
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-772-9465
-----------------------------------------------------
Fax | 212-348-4165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 048345
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------