Provider Demographics
NPI:1891944021
Name:VAUSE, LINDA NOONAN (MS, CRC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:NOONAN
Last Name:VAUSE
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W GENESEE ST # 247
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1313
Mailing Address - Country:US
Mailing Address - Phone:315-439-6970
Mailing Address - Fax:
Practice Address - Street 1:201 W GENESEE ST # 247
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1313
Practice Address - Country:US
Practice Address - Phone:315-439-6970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
00007016OtherCRC LICENSE