Provider Demographics
NPI:1043402993
Name:CUSTER, DIANE (DIANE CUSTER)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:DIANE CUSTER
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:CUSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DIANE CUSTER, MFT
Mailing Address - Street 1:80 EUREKA SQ
Mailing Address - Street 2:SUITE 151
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2654
Mailing Address - Country:US
Mailing Address - Phone:650-245-1877
Mailing Address - Fax:
Practice Address - Street 1:80 EUREKA SQ
Practice Address - Street 2:SUITE 151
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2654
Practice Address - Country:US
Practice Address - Phone:650-245-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36955106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist