Provider Demographics
NPI:1346770393
Name:SHANTEAU, LEAH (LISWS, LCSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SHANTEAU
Suffix:
Gender:F
Credentials:LISWS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 COCONUT ST
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3204
Mailing Address - Country:US
Mailing Address - Phone:513-298-9155
Mailing Address - Fax:
Practice Address - Street 1:546 COCONUT ST
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3204
Practice Address - Country:US
Practice Address - Phone:513-298-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.21028881041C0700X
FLSW221821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical