Provider Demographics
NPI:1760033625
Name:FAUST, COLLEEN (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:FAUST
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FALCON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2354
Mailing Address - Country:US
Mailing Address - Phone:203-930-0025
Mailing Address - Fax:203-306-3273
Practice Address - Street 1:14 FALCON DRIVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2354
Practice Address - Country:US
Practice Address - Phone:203-930-0025
Practice Address - Fax:203-306-3273
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty