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General NPI Number Information
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NPI Number | 1174644652
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Entity Type | Organization
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Legal Business Name | LIBERATION PROGRAMS INC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 120 BROOKSIDE ROAD
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City | DARIEN
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State | CT
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Zip | 06820
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Country | US
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Telephone | 203-655-8973
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Fax | 203-655-2389
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Provider Business Mailing Address
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Address Line | 4 ELMCREST TER
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City | NORWALK
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State | CT
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Zip | 06850-3908
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Country | US
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Telephone | 203-851-2077
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Fax | 203-851-2082
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ALAN MATHIS
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Credential |
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Telephone | 203-851-2077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 0271
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License Number State | CT
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