Provider Demographics
NPI:1215512900
Name:LEDET, RAYSHAWN
Entity type:Individual
Prefix:
First Name:RAYSHAWN
Middle Name:
Last Name:LEDET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LAMONT AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-2736
Mailing Address - Country:US
Mailing Address - Phone:732-710-5515
Mailing Address - Fax:
Practice Address - Street 1:29 LAMONT AVE APT 11
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-2736
Practice Address - Country:US
Practice Address - Phone:732-710-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059571001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical