Healthcare Provider Details

I. General information

NPI: 1659654812
Provider Name (Legal Business Name): LINDA KAPUSTA M.S., CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KROSS KEYS DR
ALBANY NY
12205-1466
US

IV. Provider business mailing address

2 KROSS KEYS DR
ALBANY NY
12205-1466
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-4800
  • Fax:
Mailing address:
  • Phone: 518-438-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number2401627
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2401627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: