NPIMap

Organization Active NPI

Lifebridge Community Services, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fairfield, CT
National Provider Identifier
1750378667
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LIFEBRIDGE COMMUNITY SERVICES, INC
Practice address
125 Penfield Road
Fairfield, CT 06824-6639
Phone
(203) 255-5777
Fax
(203) 259-9673
NPI assigned
Oct 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Authorized official

Name
Frank Farias
Title
Chief Financial & HR Officer
Phone
(203) 368-4291

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 0334 CT
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 0400 CT
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0400 CT
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X CT Primary

Addresses

Primary practice location

125 Penfield Road
Fairfield, CT 06824-6639

Mailing address

125 Penfield Rd.
Fairfield, CT 06824-6639
Phone (203) 255-5777

Other identifiers 2

IdentifierTypeStateIssuer
004069985MedicaidCT
004083606MedicaidCT

Other names 1

  • Fairfield Counseling Services, Inc Other name

National Provider Directory

National Provider Directory
Tax ID family
Fairfield Counseling Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1750378667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 PENFIELD RD.",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246639",
            "telephone_number": "203-255-5777",
            "fax_number": "203-259-9673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 PENFIELD ROAD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246639",
            "telephone_number": "203-255-5777",
            "fax_number": "203-259-9673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "FARIAS",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL & HR OFFICER",
        "authorized_official_telephone_number": "203-368-4291"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "0334",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CT",
            "license": "0400",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "0400",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004069985",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004083606",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairfield Counseling Services, Inc",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Fairfield Counseling Services, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.