Organization
LIBERATION PROGRAMS INC
Active
Other names
Liberation Meridian Guenster
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALAN MATHIS (CHIEF EXECUTIVE OFFICER)
(203) 851-2077
Entity
Organization
Contact information
Practice address
115 MAIN ST, STAMFORD, CT 06901-2818
(203) 356-1980
(203) 967-9476
Mailing address
4 ELMCREST TER, NORWALK, CT 06850-3908
(203) 851-2077
(203) 851-2082
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
SA0175
CT
261QM2800X
Methadone Clinic
SA0175
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004052023
—
CT
05
—
004188282
—
CT
05
—
004251493
—
CT
Enumeration date
03/30/2007
Last updated
06/27/2008
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