Provider Demographics
NPI:1679911937
Name:FAWCETT, COLLEEN NEE (LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:NEE
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 REDDING RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4923
Mailing Address - Country:US
Mailing Address - Phone:203-246-4793
Mailing Address - Fax:
Practice Address - Street 1:49 NEW ST
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4917
Practice Address - Country:US
Practice Address - Phone:203-246-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical