Provider Demographics
NPI:1033983259
Name:OSBURN, KRISTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:OSBURN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BUXTON FARM RD STE 105
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1210
Mailing Address - Country:US
Mailing Address - Phone:203-674-8200
Mailing Address - Fax:
Practice Address - Street 1:30 BUXTON FARM RD STE 105
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1210
Practice Address - Country:US
Practice Address - Phone:203-674-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1791103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst