NPIMap

Organization Active NPI

Liberation Programs Inc

  • Addiction (Substance Use Disorder) Counselor
  • Bridgeport, CT
National Provider Identifier
1316060940
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
0290 Issued in CT
Legal business name
LIBERATION PROGRAMS INC
Practice address
399 Mill Hill Ave
Bridgeport, CT 06610-2865
Phone
(888) 822-2270
Fax
(203) 336-4395
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Alan Mathis
Title
Chief Executive Officer
Phone
(203) 851-2077

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 0290 CT Primary

Addresses

Primary practice location

399 Mill Hill Ave
Bridgeport, CT 06610-2865

Mailing address

4 Elmcrest Ter
Norwalk, CT 06850-3908
Phone (203) 851-2077

Other identifiers 2

IdentifierTypeStateIssuer
77ABH0051CT01OtherCTBLUECROSS BLUESHIELD
42BOtherCTBLUECROSS BLUESHIELD

Other names 1

  • Liberation Meridian Guenster Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Liberation Programs in9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

399 Mill Hill Ave
Bridgeport, CT 06610
Phone (203) 384-9301

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316060940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 ELMCREST TER",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503908",
            "telephone_number": "203-851-2077",
            "fax_number": "203-851-2082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "399 MILL HILL AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102865",
            "telephone_number": "888-822-2270",
            "fax_number": "203-336-4395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERATION PROGRAMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "203-851-2077",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "0290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "77ABH0051CT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "42B",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberation Meridian Guenster",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.