NPIMap

Organization Active NPI

Liberation Programs Inc

  • Adult Mental Health Clinic/Center
  • Bridgeport, CT
National Provider Identifier
1316067481
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
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
Mar 30, 2007
Last updated
Jun 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 0290 CT Primary
Methadone Clinic 261QM2800X 0290 CT

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 3

IdentifierTypeStateIssuer
004238764MedicaidCT
004191962MedicaidCT
004251500MedicaidCT

Other names 1

  • Liberation Meridian Guenster Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200123000527 CT Part B Supplier - Opioid Treatment Program (Otp) 8729413604 1 other NPI on this enrollment
Practice locations: Stamford, CT; Bridgeport, CT
O20211028002480 CT Part B Supplier - Clinic/Group Practice 8729413604 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
Practice locations: Stamford, CT; Greenwich, CT; Bridgeport, CT

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

339 West Ave
Bridgeport, CT 06604

129 Glover Ave
Norwalk, CT 06850
Phone (203) 604-1243

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1316067481",
    "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": "2007-03-30",
        "last_updated": "2008-06-27",
        "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": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CT",
            "license": "0290",
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "CT",
            "license": "0290",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004238764",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004191962",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004251500",
            "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 Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.