Provider Demographics
NPI:1811497902
Name:LAMBERT, MACY RENEE (PCSS)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:RENEE
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:PCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COUNTY ROAD 289
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-8274
Mailing Address - Country:US
Mailing Address - Phone:662-423-8838
Mailing Address - Fax:662-423-3331
Practice Address - Street 1:1223 MARIA LN
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1139
Practice Address - Country:US
Practice Address - Phone:662-423-3332
Practice Address - Fax:662-423-3331
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018204Medicaid