Provider Demographics
NPI:1184787368
Name:CUSTER, MARY R (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:CUSTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CUSTER
Other - Last Name:GLOYSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 EAST 26TH ST
Mailing Address - Street 2:ATTN ANN MARIE ERNST
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504
Mailing Address - Country:US
Mailing Address - Phone:814-453-7138
Mailing Address - Fax:
Practice Address - Street 1:301 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1440
Practice Address - Country:US
Practice Address - Phone:814-455-4009
Practice Address - Fax:814-455-7715
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional