Provider Demographics
NPI:1851452718
Name:MCLEOD, SHAUN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:
Last Name:MCLEOD
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 1:12 FRAZER DR
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2007
Mailing Address - Country:US
Mailing Address - Phone:631-793-2922
Mailing Address - Fax:
Practice Address - Street 1:12 FRAZER DR
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-2007
Practice Address - Country:US
Practice Address - Phone:631-793-2922
Practice Address - Fax:718-761-3017
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0568371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN6R431Medicare ID - Type UnspecifiedMEDICARE