Provider Demographics
NPI:1114720034
Name:LEEDER, SHOSHANA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHOSHANA
Middle Name:
Last Name:LEEDER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 YOLO AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2614
Mailing Address - Country:US
Mailing Address - Phone:650-269-2816
Mailing Address - Fax:
Practice Address - Street 1:410 12TH ST STE 325
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4489
Practice Address - Country:US
Practice Address - Phone:650-269-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94026354103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist