Individual provider Active NPI

Eugene Gillen

  • Clinical Social Worker
  • Alexandria, VA
National Provider Identifier
1306244710
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904016372 Issued in VA
Practice address
6210 Old Franconia Rd Unit a
Alexandria, VA 22310-2529
Phone
(703) 955-3703
NPI assigned
Dec 17, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 0904016372 VA Primary

Addresses

Primary practice location

6210 Old Franconia Rd Unit a
Alexandria, VA 22310-2529

Mailing address

6210 Old Franconia Rd Unit a
Alexandria, VA 22310-2529
Phone (703) 955-3703

Other practice location 1

3375 S Hoover St
Suite H201
Los Angeles, CA 90089-0116
Phone (213) 821-5977

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260208000105 VA Practitioner - Clinical Social Worker 8729567078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

505 Main St
Toms River, NJ 08753-7443

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904016372VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lifebulb LLC Single Specialty CurrentSince Nov 29, 2025 Accepting new patients

Locations

505 Main St
Toms River, NJ 08753
Phone (732) 272-0127

6210 Old Franconia Rd
#A
Alexandria, VA 22310
Phone (703) 955-3703

2340 Commonwealth Dr
Ste 101
Charlottesville, VA 22901
Phone (732) 451-3895

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1306244710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 OLD FRANCONIA RD UNIT A",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223102529",
            "telephone_number": "703-955-3703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6210 OLD FRANCONIA RD UNIT A",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223102529",
            "telephone_number": "703-955-3703"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3375 S Hoover St",
            "address_2": "Suite H201",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900890116",
            "country_code": "US",
            "telephone_number": "213-821-5977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLEN",
        "first_name": "EUGENE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-17",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904016372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

Verify at the official NPI Registry.