Provider Demographics
NPI:1831155217
Name:VINCENT, LINDA CAROLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:CAROLE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3109
Mailing Address - Country:US
Mailing Address - Phone:413-585-9991
Mailing Address - Fax:413-585-9902
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3109
Practice Address - Country:US
Practice Address - Phone:413-585-9991
Practice Address - Fax:413-585-9902
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4010103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21719Medicare ID - Type Unspecified