NPIMap

Organization Active NPI

Liberation Programs Inc

  • Adult Mental Health Clinic/Center
  • Stamford, CT
National Provider Identifier
1649390733
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
SA0175 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
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 SA0175 CT Primary
Methadone Clinic 261QM2800X SA0175 CT

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 3

IdentifierTypeStateIssuer
004052023MedicaidCT
004251493MedicaidCT
004188282MedicaidCT

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
This NPI is an additional NPI on the 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
This NPI is an additional NPI on the 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
Tax ID family
Liberation Programs Inc9 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

117 W Main St
Stamford, CT 06902
Phone (203) 356-1980

125 Main St
Stamford, CT 06901
Phone (203) 391-7906

Practitioners & affiliated clinicians

Practitioners 23

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 23

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": "1649390733",
    "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": "2007-03-30",
        "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": "SA0175",
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "CT",
            "license": "SA0175",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004052023",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004251493",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004188282",
            "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.
  • 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.