Active NPI
Mary R Custer, LPC
- Professional Counselor
- Erie, PA
National Provider Identifier
1184787368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC003084
- Practice address
- 301 W 10TH St
Erie, PA 16502-1440 - Phone
- (814) 455-4009
- Fax
- (814) 455-7715
- NPI assigned
- Dec 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC003084 | PA | Primary |
Addresses
Primary practice location
301 W 10TH St
Erie, PA 16502-1440
Mailing address
138 East 26TH St
Attn Ann Marie Ernst
Erie, PA 16504
Phone (814) 453-7138
Other names 1
- Mary Custer Gloystein
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC003084 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Erie Counseling Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Erie, PA
- NPI 1598829616
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1184787368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 EAST 26TH ST",
"address_2": "ATTN ANN MARIE ERNST",
"city": "ERIE",
"state": "PA",
"postal_code": "16504",
"telephone_number": "814-453-7138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 W 10TH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165021440",
"telephone_number": "814-455-4009",
"fax_number": "814-455-7715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTER",
"first_name": "MARY",
"middle_name": "R",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC003084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "GLOYSTEIN",
"middle_name": "CUSTER",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.