Provider Demographics
NPI:1659654812
Name:KAPUSTA, LINDA (MS, CAS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KAPUSTA
Suffix:
Gender:F
Credentials:MS, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KROSS KEYS DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1466
Mailing Address - Country:US
Mailing Address - Phone:518-438-4800
Mailing Address - Fax:
Practice Address - Street 1:2 KROSS KEYS DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1466
Practice Address - Country:US
Practice Address - Phone:518-438-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2401627251300000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool