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General NPI Number Information
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NPI Number | 1609122100
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Entity Type | Individual
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Provider Name | SUSAN LEIDEMER LPC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1 DEMERCURIO DRIVE SUITE 2
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City | ALLENDALE
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State | NJ
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Zip | 07401
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Country | US
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Telephone | 551-233-2310
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Fax | 201-571-6177
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Provider Business Mailing Address
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Address Line | 22 OTTAWA AVE
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City | HASBROUCK HEIGHTS
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State | NJ
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Zip | 07604-1409
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Country | US
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Telephone | 201-390-2209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00352100
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License Number State | NJ
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