Libertae, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

093149 Issued in PA

Legal business name

LIBERTAE, INC.

Practice address

5245 Bensalem Blvd
Bensalem, PA 19020-4076

Phone

(215) 639-8681

Fax

(215) 639-4277

NPI assigned

Apr 19, 2007

Last updated

Apr 9, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Connie Bastek Karasow, M.S.W.

Title

Executive Director

Phone

(215) 639-8681

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239235200000",
    "number": "1649497793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5245 BENSALEM BLVD",
            "city": "BENSALEM",
            "state": "PA",
            "postal_code": "190204076",
            "telephone_number": "215-639-8681",
            "fax_number": "215-639-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5245 BENSALEM BLVD",
            "city": "BENSALEM",
            "state": "PA",
            "postal_code": "190204076",
            "telephone_number": "215-639-8681",
            "fax_number": "215-639-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTAE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2009-04-09",
        "status": "A",
        "authorized_official_last_name": "KARASOW",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "BASTEK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "215-639-8681",
        "authorized_official_credential": "M.S.W."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "097074",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "093149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001627736",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016277360001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2009; 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.