Provider Demographics
NPI:1497749964
Name:MACY, PEGGY (LCSW)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:MACY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:MACY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4700 SPRING ST
Mailing Address - Street 2:STE 204
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5263
Mailing Address - Country:US
Mailing Address - Phone:619-465-4700
Mailing Address - Fax:619-589-6840
Practice Address - Street 1:4700 SPRING ST
Practice Address - Street 2:STE 204
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5263
Practice Address - Country:US
Practice Address - Phone:619-465-4700
Practice Address - Fax:619-589-6840
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS44951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW4495Medicare UPIN
R38719Medicare ID - Type Unspecified