JOHN MARK CUSTER (NPI# 1487125738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487125738 |
| Entity Type | Individual |
| Full Name | JOHN MARK CUSTER |
| Credential | LCSW |
| Practice Address |
3550 N Interstate Ave Portland OR 97227-1196 |
| Mailing Address |
7224 Sw Capitol Hwy Portland OR 97219-2429 |
| Practice Telephone | 5033880042 |
| Mailing Telephone | 5033193420 |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
1462 | OR | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578679452 | John Vernon Custer | Specialist | 1 Poston Rd, Suite 145, Charleston, SC 29407-3424 | 2006-08-22 |
| Street Address |
3550 N INTERSTATE AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97227-1196 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255335295 | Brenda R Annotti | Registered Nurse | 3550 N Interstate Ave, Portland, OR 97227 | 2005-06-08 |
| 1124633326 | Ajna Rae | Counselor | 3550 N Interstate Ave, Portland, OR 97227-1196 | 2020-09-14 |
| 1649822420 | Rosa Ahn | Student in an Organized Health Care Education/Training Program | 3550 N Interstate Ave, Portland, OR 97227-1196 | 2019-07-12 |
| 1154882132 | Casey Grad Granbois | Student in an Organized Health Care Education/Training Program | 3550 N Interstate Ave, Portland, OR 97227-1196 | 2019-03-30 |
| 1750855425 | Julie Catherine Leffler | Student in an Organized Health Care Education/Training Program | 3550 N Interstate Ave, Portland, OR 97227-1196 | 2019-01-16 |
| 1548776842 | Heather Jacobs | Registered Nurse | 3550 N Interstate Ave, Portland, OR 97227-1196 | 2017-12-21 |
| 1245764075 | Ryan Nesbit | Student in an Organized Health Care Education/Training Program | 3550 N Interstate Ave, Portland, OR 97227-1196 | 2017-04-19 |
| 1023552460 | Chia Neng Vang | Pharmacist | 3550 N Interstate Ave, Portland, OR 97227-1196 | 2016-12-04 |
| 1295278307 | Fideliz Enrile Lim | Pharmacist | 3550 N Interstate Ave, Portland, OR 97227-1196 | 2016-11-21 |
| 1750833364 | Kimberlyy Nguyen | Pharmacist | 3550 N Interstate Ave, Portland, OR 97227-1196 | 2016-10-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466574 | Jessica Michelle Simonetti | Psychologist | Portland Psychotherapy Clinic, Research and Training Ce, 3700 N Williams Ave, Portland, OR 97227 | 2020-10-29 |
| 1447812268 | Maksim Yefimov | Physician Assistant | 2800 N Vancouver Ave Ste 130, Portland, OR 97227 | 2019-07-01 |
| 1851955975 | Erin Marie Staples | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave;, Suite 230, Portland, OR 97227 | 2019-04-24 |
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1730615071 | Mehran Giblin | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave, Suite 230, Legacy Clinic Emanuel, Portland, OR 97227 | 2017-05-05 |
| 1730623687 | Christina Grace Belter | Optometrist | 300 N Graham St Ste 300, Portland, OR 97227 | 2016-12-12 |
| 1407300205 | Jenna Abernathy | Counselor | 3537 N Williams Ave, Portland, OR 97227 | 2016-08-09 |
| 1215390760 | Tanya Marie Woods | Massage Therapist | 3808 N. Williams Ave., Portland, OR 97227 | 2016-04-01 |
| 1033596853 | Eric Allen Martin | Counselor | 2054 N. Vancouver Ave, Portland, OR 97227 | 2015-04-30 |
| 1285040436 | Berk Neurosurgical LLC | Neurological Surgery | 501 N Graham St Ste 500, Portland, OR 97227 | 2014-07-09 |
| Find all providers in zip 97227 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063012649 | Kathleen Russell | Social Worker | 7700 Sw Garden Home Rd Apt 23, Portland, OR 97223-7496 | 2020-10-31 |
| 1275131534 | Alice Hacker | Social Worker | 14702 Se Rhone St, Portland, OR 97236-2557 | 2020-10-09 |
| 1598372070 | Kristin Elizabeth Hajny | Social Worker | 9343 Sw Camille Ter, Portland, OR 97223-7042 | 2020-09-28 |
| 1821605759 | Melanie Smith | Social Worker | 4210 N Juneau St, Portland, OR 97203-2063 | 2020-09-24 |
| 1871100867 | Purely Spirit Holistic Health, LLC | Social Worker | 226 Stevens Ave Apt 9, Portland, ME 04102-2263 | 2020-09-24 |
| 1023624780 | Flourish Counseling and Consulting LLC | Social Worker | 8401 Ne Halsey St Ste 107, Portland, OR 97220-5670 | 2020-09-18 |
| 1245845130 | Crescent Psychotherapy | Social Worker | 168 Neal St, Portland, ME 04102-3343 | 2020-09-09 |
| 1861007676 | Yvonne Recchia | Social Worker | 5257 Ne Mlk, Portland, OR 97211-3282 | 2020-09-09 |
| 1447864327 | Gordon Keepers | Social Worker | 3181 Sw Sam Jackson Park Rd # Uhs8-l, Portland, OR 97239-3098 | 2020-09-08 |
| 1609484187 | Julie Pratt | Social Worker | 14 Culver Ln, Portland, CT 06480-1323 | 2020-07-21 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.