Provider Demographics
NPI:1932584570
Name:BOYS & GIRLS VILLAGE
Entity type:Organization
Organization Name:BOYS & GIRLS VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IICAPS CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:MA MFT
Authorized Official - Phone:203-690-5159
Mailing Address - Street 1:8 1/2 GIRARD ST
Mailing Address - Street 2:APT. B
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850
Mailing Address - Country:US
Mailing Address - Phone:203-722-1728
Mailing Address - Fax:
Practice Address - Street 1:170 BENNETT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2901
Practice Address - Country:US
Practice Address - Phone:203-330-6790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health