Provider Demographics
NPI:1609122100
Name:LEIDEMER, SUSAN (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LEIDEMER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1409
Mailing Address - Country:US
Mailing Address - Phone:201-390-2209
Mailing Address - Fax:
Practice Address - Street 1:1 DEMERCURIO DRIVE SUITE 2
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401
Practice Address - Country:US
Practice Address - Phone:551-233-2310
Practice Address - Fax:201-571-6177
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00352100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional