MRS. EBONY J MAC (LCSW) – Clinical Social Worker, NPI 1063747772
Clinical Social Worker
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,245 CLINICAL SOCIAL WORKER in MO
Provider Addresses for MRS. EBONY J MAC (LCSW)
3309 S KINGSHIGHWAY BLVD
SAINT LOUIS, MO 631391101
Phone: (314) 206-3700
Fax: (314) 206-3708
Type: Mailing
6643 CHAMBERLAIN AVE
SAINT LOUIS, MO 631302636
Phone: (314) 465-5351
Fax: (314) 465-5351
Type: Mailing
401 PINE ST
SAINT LOUIS, MO 631022731
Phone: (314) 465-5351
Type: Location
330, North Gore Avenue, Webster Groves, Saint Louis County, Missouri, 63119, United States
SAINT LOUIS, MO 631191600
Phone: (314) 968-2060
Fax: (314) 968-8308
Type: Location
Brook Avenue South, Browndale, Saint Louis Park, Hennepin County, Minnesota, 55424, United States
SAINT LOUIS, MO 631252902
Phone: (314) 814-1057
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-10-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20220802001898 | I | Clinical Social Worker | MO | TBD |
| I20231016002099 | I | Clinical Social Worker | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 63139)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | MO | |
| P S Y C H I A T R Y | MO | |
| Clinical Social Worker | MO | |
| Mental Health Counselor | MO | |
| P S Y C H I A T R Y | MO | |
| Clinical Social Worker | MO | |
| Mental Health Counselor | MO | |
| P S Y C H I A T R Y | OH | |
| Clinical Social Worker | MO | |
| Clinical Social Worker | VA |
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