Provider Demographics
NPI:1437776515
Name:PENZONE, COLLEEN CATHERINE (EDD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:CATHERINE
Last Name:PENZONE
Suffix:
Gender:F
Credentials:EDD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NEELD LN
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-2009
Mailing Address - Country:US
Mailing Address - Phone:610-329-8580
Mailing Address - Fax:
Practice Address - Street 1:4 NEELD LN
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-2009
Practice Address - Country:US
Practice Address - Phone:610-329-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-18-33840103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst