Provider Demographics
NPI:1649340332
Name:SCHARLATT, MARK PAUL (LCSWR)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:PAUL
Last Name:SCHARLATT
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9514 BUCKTOOTH RUN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14755-9751
Mailing Address - Country:US
Mailing Address - Phone:716-938-6191
Mailing Address - Fax:716-648-0666
Practice Address - Street 1:97 S BUFFALO ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-6212
Practice Address - Country:US
Practice Address - Phone:716-648-0650
Practice Address - Fax:716-648-0666
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049309104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00671792Medicaid
NY00671792Medicaid