Provider Demographics
NPI:1649405887
Name:APT FOUNDATION INC
Entity Type:Organization
Organization Name:APT FOUNDATION INC
Other - Org Name:LEGION AVENUE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:203-781-4600
Mailing Address - Street 1:1 LONG WHARF DR
Mailing Address - Street 2:SUITE 321
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5991
Mailing Address - Country:US
Mailing Address - Phone:203-781-4600
Mailing Address - Fax:203-781-4624
Practice Address - Street 1:495 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1312
Practice Address - Country:US
Practice Address - Phone:203-781-4740
Practice Address - Fax:203-781-4751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0476261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008022622OtherLEGION/MEDICAID/MH
CT008037391OtherSHACKELL MEDICAID
CT008050785OtherDROZD MEDICAID
CT008070113Medicaid
CT001302497OtherSHI MEDICAID
CT008003745OtherDESROSIERS MEDICAID
CT001423136OtherTETRAULT MEDICAID
CT008069472OtherPOTWARDOWSKI MEDICAID
CT008038052OtherNODELMAN MEDICAID
CT008038037OtherEGGERT MEDICAID
CT008045323OtherGARCIA MEDICAID
CT008066293OtherMARDAM BEY MEDICAID
CT008061961OtherSMALL-OIE MEDICAID
CT001340132OtherSAVAGE MEDICAID
CT008038053OtherROEHRICH MEDICAID
CT008048393OtherBARRY MEDICAID
CT008050854OtherBUTNER MEDICAID
CT008053091OtherBUTNER MEDICAID
CT001218107OtherSCHOTTENFELD MEDICAID
CT008050785OtherDROZD MEDICAID
CTD400083844Medicare PIN
CT001218107OtherSCHOTTENFELD MEDICAID
CT001340132OtherSAVAGE MEDICAID
CT008022622OtherLEGION/MEDICAID/MH
CT008066293OtherMARDAM BEY MEDICAID
CTD400353164Medicare PIN
CTD400082726Medicare PIN
CTD400081097Medicare PIN
CTD400172220Medicare PIN
COD400081097OtherTETRAULT MEDICARE
CT008061961OtherSMALL-OIE MEDICAID
COD400081097OtherTETRAULT MEDICARE