| Doctor Name: | SHANNON COLLEEN LEITH |
| NPI Number: | 1093107047 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | ISW6109 |
| Business Practice Address: | 2418 Bellarosa Cir Royal Palm Beach, FL - 334111469 |
| Business Phone Number: | 5615783125 |
| Business Fax Number: | |
| Mailing Address: | 2418 Bellarosa Cir, ROYAL PALM BEACH |
| State: | FL |
| Postal Code: | 334111469 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/27/2015 |
| NPI Last Update Date: | 02/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | ISW6109 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |