Healthcare Provider Details

I. General information

NPI: 1487569810
Provider Name (Legal Business Name): COLINE CAMBURN MA, BSL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 COWPATH RD
SOUDERTON PA
18964-2036
US

IV. Provider business mailing address

512 PERKIOMEN AVE
LANSDALE PA
19446-3431
US

V. Phone/Fax

Practice location:
  • Phone: 267-203-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008522
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: