| Liberation Programs Inc | |
|
115 Main St Stamford CT 06901-2818 | |
| (203) 356-1980 | |
| (203) 967-9476 |
| Full Name | Liberation Programs Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 115 Main St, Stamford, Connecticut |
| Authorized Official Name and Position | Alan Mathis (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2038512077 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liberation Programs Inc 4 Elmcrest Ter Norwalk CT 06850-3908 Ph: (203) 851-2077 | Liberation Programs Inc 115 Main St Stamford CT 06901-2818 Ph: (203) 356-1980 |
| NPI Number | 1649390733 |
|---|---|
| Provider Enumeration Date | 03/30/2007 |
| Last Update Date | 06/27/2008 |
| Medicare PECOS PAC ID | 8729413604 |
|---|---|
| Medicare Enrollment ID | O20200123000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649390733 | NPI | - | NPPES |
| 004251493 | Medicaid | CT | |
| 004052023 | Medicaid | CT | |
| 004188282 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | SA0175 (Connecticut) | Primary |
| 261QM2800X | Clinic/center - Methadone | SA0175 (Connecticut) | Secondary |
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