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Organization
BOYS & GIRLS VILLAGE
Active
Organization
BOYS & GIRLS VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. L. KENNETH FELLENBAUM (CEO)
(203) 877-0300
Entity
Organization
Contact information
Practice address
528 WHEELERS FARMS RD, MILFORD, CT 06461-1847
(203) 877-0300
(203) 876-0076
Mailing address
528 WHEELERS FARMS RD, MILFORD, CT 06461-1847
(203) 877-0300
(203) 876-0076
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
CPA-40
CT
261QM0855X
Adolescent and Children Mental Health Clinic/Center
EDT-10
CT
261QM0855X
Adolescent and Children Mental Health Clinic/Center
OPCC-38
CT
323P00000X
Psychiatric Residential Treatment Facility
CCF/TS 17
CT
Other
Enumeration date
07/04/2006
Last updated
09/11/2025
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