BOYS & GIRLS VILLAGE NPI 1477583581

NPI Information

NPI: 1477583581
Provider Name: BOYS & GIRLS VILLAGE
Classification: Clinic/Center - 261QM0855X
Entity Type: Organization

Specialization: Adolescent and Children Mental Health

CLIA Number: 07D2180467

Address:
528 WHEELERS FARMS RD
MILFORD, CT
ZIP 06461
Phone: (203) 877-0300
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BOYS & GIRLS VILLAGE is an adolescent and children mental health clinic center in Milford, CT. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. BOYS & GIRLS VILLAGE NPI is 1477583581. The provider is registered as an organization entity type.

The provider's business location address is:

528 WHEELERS FARMS RD
MILFORD, CT
ZIP 06461-847
Phone: (203) 877-0300
Fax: (203) 876-0076

The provider's authorized official is L. Kenneth Fellenbaum .
The authorized official title is Ceo and has the following contact phone number (203) 877-0300.

The CLIA number assigned to this NPI record is 07D2180467 - home health agency with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/4/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	EDT-10	CONNECTICUT	Yes
2	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	OPCC-38	CONNECTICUT	X
3	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	CPA-40	CONNECTICUT	X
4	323P00000X	Psychiatric Residential Treatment Facility		CCF/TS 17	CONNECTICUT	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	004189173-00	MEDICAID	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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