Misty Smith Pilgrim, MED, MA, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW61557825 Issued in WA

Practice address

46 Village Way # 107
Port Ludlow, WA 98365-5102

Phone

(505) 501-8293

Fax

(505) 521-5149

NPI assigned

Sep 22, 2009

Last updated

Jul 8, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 5, 2025 through May 5, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts, Master of Education

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pilgrim Behavioral Health

  • Clinical Social Worker
  • Lacey, WA
  • NPI 1568137370

  Professional

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1790019826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 VILLAGE WAY # 107",
            "city": "PORT LUDLOW",
            "state": "WA",
            "postal_code": "983655102",
            "telephone_number": "505-501-8293",
            "fax_number": "505-521-5149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 VILLAGE WAY # 107",
            "city": "PORT LUDLOW",
            "state": "WA",
            "postal_code": "983655102",
            "telephone_number": "505-501-8293",
            "fax_number": "505-521-5149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PILGRIM",
        "first_name": "MISTY",
        "middle_name": "SMITH",
        "name_prefix": "Ms.",
        "credential": "MED, MA, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-22",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "SWB-2022-0189",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61557825",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "LCSW-5066",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willow Odonnell, LMT
• Lloyd Russell Owen Jr.
• Pacific Vascular Incorporated
• Allen Panasuk, OD
• Marjorie L Pederson, DC
• Stephen Patrick Porter, D.M.D.
• Katherine Read
• James Forrest Redman, DO
• Jillian Rebecca Rifkind, EAMP
• John E Sailer, M.D.

• Clinical Social Worker in Port Ludlow, WA
• Providers in Port Ludlow, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.