Organization
BOYS AND GIRLS VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA AMATO (IICAPS CLINICIAN)
(203) 980-4625
Entity
Organization
Contact information
Practice address
170 BENNETT ST, BRIDGEPORT, CT 06605-2901
(203) 980-4625
Mailing address
170 BENNETT ST, BRIDGEPORT, CT 06605-2901
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10762370
CT
Other
Enumeration date
03/28/2017
Last updated
03/28/2017
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