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Individual
MATTHEW C LEISURE
Active
Individual
MATTHEW C LEISURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, CAC, SAP
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW013624
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01099202
CAPITAL BLUE CROSS
PA
01
—
2055191
CIGNA BEHAVIORAL HEALTH
PA
01
—
273437000
MAGELLAN
PA
01
—
294505
MAMSI
PA
01
—
453317
VALUE OPTIONS
PA
01
—
612348
BC/BS OF MD CARE FIRST
PA
Enumeration date
06/11/2006
Last updated
07/21/2016
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