NPIMap

Organization Active NPI

Liberation Programs Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Stamford, CT
National Provider Identifier
1407978356
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
0324 Issued in CT
Legal business name
LIBERATION PROGRAMS INC
Practice address
115 Main St
Stamford, CT 06901-2818
Phone
(203) 356-1980
Fax
(203) 967-9476
NPI assigned
Apr 4, 2007
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 0324 CT Primary

Addresses

Primary practice location

115 Main St
Stamford, CT 06901-2818

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
004258366MedicaidCT

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

115 Main St
Stamford, CT 06901
Phone (203) 356-1980

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1407978356",
    "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": "115 MAIN ST",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069012818",
            "telephone_number": "203-356-1980",
            "fax_number": "203-967-9476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERATION PROGRAMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "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": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CT",
            "license": "0324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004258366",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberation Meridian Guenster",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Stamford, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.