Provider Demographics
NPI:1164265674
Name:PILGRIM, MACY ELIZABETH (LMSW)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:ELIZABETH
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 BRANDON PARK DR APT D
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8719
Mailing Address - Country:US
Mailing Address - Phone:785-458-9226
Mailing Address - Fax:
Practice Address - Street 1:320 GRAVOIS RD STE 210
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4122
Practice Address - Country:US
Practice Address - Phone:314-467-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical