| Liberation Programs Inc | |
|
399 Mill Hill Ave Bridgeport CT 06610-2865 | |
| (888) 822-2270 | |
| (203) 336-4395 |
| Full Name | Liberation Programs Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 399 Mill Hill Ave, Bridgeport, 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 399 Mill Hill Ave Bridgeport CT 06610-2865 Ph: (888) 822-2270 |
| NPI Number | 1316067481 |
|---|---|
| Provider Enumeration Date | 03/30/2007 |
| Last Update Date | 06/27/2008 |
| Medicare PECOS PAC ID | 8729413604 |
|---|---|
| Medicare Enrollment ID | O20211028002480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316067481 | NPI | - | NPPES |
| 004191962 | Medicaid | CT | |
| 004251500 | Medicaid | CT | |
| 004238764 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 0290 (Connecticut) | Primary |
| 261QM2800X | Clinic/center - Methadone | 0290 (Connecticut) | Secondary |
| Provider Name | Sunil Saxena |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346259637 PECOS PAC ID: 7012928997 Enrollment ID: I20060505000892 |
| Provider Name | Kathleen A Ennis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750417358 PECOS PAC ID: 6103906516 Enrollment ID: I20080110000159 |
| Provider Name | Clive Lloyd Johnson |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1053500447 PECOS PAC ID: 4183713142 Enrollment ID: I20100111000634 |
| Provider Name | Cassandra K Scott |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144503285 PECOS PAC ID: 8123278793 Enrollment ID: I20121017000761 |
| Provider Name | Lucinda Margaret Dubois |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215460472 PECOS PAC ID: 7618219791 Enrollment ID: I20190422002092 |
| Provider Name | Emily Rachel Mihailescu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053970939 PECOS PAC ID: 9537499694 Enrollment ID: I20191002003759 |
| Provider Name | Ann B Mccue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609317536 PECOS PAC ID: 6901294685 Enrollment ID: I20211029000477 |
| Provider Name | Shalenta Hardison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598176273 PECOS PAC ID: 7719376946 Enrollment ID: I20211110000280 |
| Provider Name | Amy Leigh Dorsey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811489545 PECOS PAC ID: 2466845847 Enrollment ID: I20220207002176 |
| Provider Name | Ruth S Theaman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134858806 PECOS PAC ID: 9638542640 Enrollment ID: I20230222000654 |
| Provider Name | Brittany Albano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083022545 PECOS PAC ID: 3072971738 Enrollment ID: I20230628001215 |
| Provider Name | Rose Shea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801511217 PECOS PAC ID: 9739541707 Enrollment ID: I20230809000208 |
| Provider Name | Kenneth E Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275203168 PECOS PAC ID: 4789037961 Enrollment ID: I20240124003762 |
| Provider Name | Yeharar Stephen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497348494 PECOS PAC ID: 2264875806 Enrollment ID: I20240209003338 |
| Provider Name | Anne Tarnasky |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144850082 PECOS PAC ID: 5193168755 Enrollment ID: I20240210000240 |
| Provider Name | Virginia E Taverner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174961437 PECOS PAC ID: 0941645279 Enrollment ID: I20240227001233 |
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