Provider Demographics
NPI:1477595890
Name:LEISURE, MATTHEW C (MSW, CAC, SAP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:LEISURE
Suffix:
Gender:M
Credentials:MSW, CAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6349
Practice Address - Street 1:3550 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6340
Practice Address - Fax:717-851-6349
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW013624104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA294505OtherMAMSI
PA612348OtherBC/BS OF MD CARE FIRST
PA273437000OtherMAGELLAN
PA2055191OtherCIGNA BEHAVIORAL HEALTH
PA453317OtherVALUE OPTIONS
PA01099202OtherCAPITAL BLUE CROSS