NPIMap

Organization Active NPI

Boys & Girls Village

  • Adolescent and Children Mental Health Clinic/Center
  • Milford, CT
National Provider Identifier
1477583581
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
CPA-40 Issued in CT
Legal business name
BOYS & GIRLS VILLAGE
Practice address
528 Wheelers Farms Rd
Milford, CT 06461-1847
Phone
(203) 877-0300
Fax
(203) 876-0076
NPI assigned
Jul 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. L. Kenneth Fellenbaum
Title
Ceo
Phone
(203) 877-0300

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X EDT-10 CT
Adolescent and Children Mental Health Clinic/Center 261QM0855X OPCC-38 CT
Adolescent and Children Mental Health Clinic/Center 261QM0855X CPA-40 CT Primary
Psychiatric Residential Treatment Facility 323P00000X CCF/TS 17 CT

Addresses

Primary practice location

528 Wheelers Farms Rd
Milford, CT 06461-1847

Mailing address

528 Wheelers Farms Rd
Milford, CT 06461-1847
Phone (203) 877-0300

Other identifiers 1

IdentifierTypeStateIssuer
004189173-00MedicaidCT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2262853Boys & Girls Village Inc- Milford528 Wheelers Farm Rd, Milford, CT 06461Certificate of waiverJun 19, 2028

National Provider Directory

National Provider Directory
Tax ID family
Boys Girls Village4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

528 Wheelers Farms Rd
Milford, CT 06461
Phone (203) 807-0300

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1477583581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 WHEELERS FARMS RD",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064611847",
            "telephone_number": "203-877-0300",
            "fax_number": "203-876-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 WHEELERS FARMS RD",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064611847",
            "telephone_number": "203-877-0300",
            "fax_number": "203-876-0076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS & GIRLS VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "FELLENBAUM",
        "authorized_official_first_name": "L.",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-877-0300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CT",
            "license": "EDT-10",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CT",
            "license": "OPCC-38",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CT",
            "license": "CPA-40",
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "CT",
            "license": "CCF/TS 17",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004189173-00",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.