Provider Demographics
NPI:1720345986
Name:CUSTER, SHELLBY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLBY
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SCALP AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3036
Mailing Address - Country:US
Mailing Address - Phone:833-668-6861
Mailing Address - Fax:
Practice Address - Street 1:1360 EISENHOWER BLVD
Practice Address - Street 2:STE 402
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3338
Practice Address - Country:US
Practice Address - Phone:814-242-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125419104100000X
PACW0182891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker