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NPI Code Detail

MEDICARE: MR. MARK LASTER LCSW

MEDICARE:  MR. MARK  LASTER  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
11041C0700XClinical Social WorkerR026562NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578765939
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK LASTER LCSW
Provider Business Mailing Address
First Line : 6515 ALDERTON ST
Second Line :
City : REGO PARK
State : NY
Zip : 11374-5052
Country : US
Telephone Number : 646-515-9083
Fax Number :
Provider Business Practice Location Address
First Line : 6515 ALDERTON ST
Second Line :
City : REGO PARK
State : NY
Zip : 11374-5052
Country : US
Telephone Number : 646-515-9083
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2007
Last Update Date : 07/08/2007

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Directions to “ MR. MARK LASTER LCSW” Practice Location

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