Provider Demographics
NPI:1104494111
Name:LEISER, SHOSHANA R (MSED BCBA)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:R
Last Name:LEISER
Suffix:
Gender:F
Credentials:MSED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2001
Mailing Address - Country:US
Mailing Address - Phone:848-222-0970
Mailing Address - Fax:
Practice Address - Street 1:102 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2001
Practice Address - Country:US
Practice Address - Phone:848-222-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst