Provider Demographics
NPI:1265203251
Name:LEACH, MATTHEW RYAN (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:LEACH
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ROCKY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-3467
Mailing Address - Country:US
Mailing Address - Phone:207-749-9830
Mailing Address - Fax:
Practice Address - Street 1:474 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1409
Practice Address - Country:US
Practice Address - Phone:207-324-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC227231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical