Provider Demographics
NPI:1386882470
Name:LEADEM, SHAWN (LCSW)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:LEADEM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 INLAND RD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-5209
Mailing Address - Country:US
Mailing Address - Phone:732-797-1444
Mailing Address - Fax:
Practice Address - Street 1:668 COMMONS WAY BLDG I
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6431
Practice Address - Country:US
Practice Address - Phone:732-797-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44C053864001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical