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Organization
APT FOUNDATION, INC
Active
Organization
APT FOUNDATION, INC
Active
Other names
Legion Avenue Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYNN M MADDEN MPA (PRESIDENT/CHIEF EXECUTIVE OFFICER)
(203) 781-4600
Entity
Organization
Contact information
Practice address
495 CONGRESS AVE, NEW HAVEN, CT 06519-1312
(203) 781-4740
(203) 781-4751
Mailing address
1 LONG WHARF DR, SUITE 321, NEW HAVEN, CT 06511-5991
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
0230
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001218107
SCHOTTENFELD MEDICAID
CT
01
—
001302497
SHI MEDICAID
CT
01
—
001340132
SAVAGE MEDICAID
CT
01
—
001423136
TETRAULT MEDICAID
CT
01
—
004082260
LEGION/MEDICAID/MMT
CT
01
—
008003745
DESROSIERS MEDICAID
CT
01
—
008037391
SHACKELL MEDICAID
CT
01
—
008038037
EGGERT MEDICAID
CT
01
—
008038052
NODELMAN MEDICAID
CT
01
—
008038053
ROEHRICH MEDICAID
CT
01
—
008045323
GARCIA MEDICAID
CT
01
—
008048393
BARRY MEDICAID
CT
01
—
008050785
DROZD MEDICAID
CT
01
—
008053091
BUTNER MEDICAID
CT
01
—
008061961
SMALL-OIE MEDICAID
CT
01
—
008066293
MARDAM BEY MEDICAID
CT
01
—
008069472
POTWARDOWSKI MEDICAID
CT
05
—
008070113
—
CT
Enumeration date
12/29/2006
Last updated
02/21/2017
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