Basic Information
Provider Information | |||||||||
NPI: | 1861558405 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | APT FOUNDATION, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ACCESS CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 LONG WHARF DR | ||||||||
Address2: | SUITE 321 | ||||||||
City: | NEW HAVEN | ||||||||
State: | CT | ||||||||
PostalCode: | 065115991 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037814600 | ||||||||
FaxNumber: | 2037814624 | ||||||||
Practice Location | |||||||||
Address1: | 1 LONG WHARF DR | ||||||||
Address2: | SUITE 10 | ||||||||
City: | NEW HAVEN | ||||||||
State: | CT | ||||||||
PostalCode: | 065115991 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037814357 | ||||||||
FaxNumber: | 2037814705 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/28/2006 | ||||||||
LastUpdateDate: | 04/26/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MADDEN | ||||||||
AuthorizedOfficialFirstName: | LYNN | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/CHIEF EXECUTIVE OFFICER | ||||||||
AuthorizedOfficialTelephone: | 2037814600 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MPA | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | C 0265 | CT | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
ID Information
ID | Type | State | Issuer | Description | 001302497 | 01 | CT | SHI MEDICAID | OTHER | 008038040 | 01 | CT | LENCZYCKI MEDICAID | OTHER | 008063217 | 01 | CT | APPLEGET MEDICAID | OTHER | 001307439 | 01 | CT | ALTICE MEDICAID | OTHER | 001340132 | 01 | CT | SAVAGE MEDICAID | OTHER | 008038044 | 01 | CT | FARNUM MEDICAID | OTHER | 008053091 | 01 | CT | BUTNER MEDICAID | OTHER | 008064860 | 01 | CT | WEISS MEDICAID | OTHER | 008001077 | 01 | CT | MOORE MEDICAID | OTHER | 008038741 | 01 | CT | OWEN MEDICAID | OTHER | 008040283 | 01 | CT | CAMENGA MEDICAID | OTHER | 008048733 | 01 | CT | SUCHMAN MEDICAID | OTHER | 008057039 | 01 | CT | MILLER MEDICAID | OTHER | 001218107 | 01 | CT | SCHOTTENFELD MEDICAID | OTHER | 004041000 | 01 | CT | ASCESS/MEDICAID/MH | OTHER | 008037391 | 01 | CT | SHACKELL MEDICAID | OTHER | 008038043 | 01 | CT | WHELAN MEDICAID | OTHER | 008042701 | 01 | CT | KATZMAN MEDICAID | OTHER | 008058728 | 01 | CT | RIERA TIMOTHY MEDICAID | OTHER | 008069118 | 01 | CT | CAMPBELL MEDICAID # | OTHER | 008048372 | 01 | CT | SHARMAIN MEDICAID | OTHER | 008048393 | 01 | CT | BARRY MEDICAID | OTHER | 008066801 | 01 | CT | HAQUE MEDICAID | OTHER | 008038036 | 01 | CT | BAKER MEDICAID | OTHER | 008038042 | 01 | CT | POLANETSKA MEDICAID | OTHER | 008039605 | 01 | CT | HERMES MEDICAID # | OTHER | 001155787 | 01 | CT | SHIMELMAN MEDICAID | OTHER | 001423136 | 01 | CT | TETRAULT MEDICAID | OTHER | 008009745 | 01 | CT | DESROSIERS MEDICAID | OTHER | 008058058 | 01 | CT | SADINSKY MEDICAID | OTHER | 008071202 | 01 | CT | MEDICAID AMYNAH DHARANI | OTHER |