Gina Park

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904008989 Issued in VA

Practice address

10195 Main St Ste O
Fairfax, VA 22031-3415

Phone

(703) 332-1845

NPI assigned

Jun 12, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Gina Park LLC

  • Clinical Social Worker
  • Fairfax, VA
  • NPI 1568981769
  NPD Authorized official

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

{
    "created_epoch": "1434067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1477934743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9068 ANDROMEDA DR",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220153510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10195 MAIN ST STE O",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220313415",
            "telephone_number": "703-332-1845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "GINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-12",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904008989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chan Young Park
• Charles Hee Yong Park, DDS
• Cheon Gyu Park, D.C.
• Da Yon Park, PA-C
• Daniel Y Park, DPT
• Heesun Park
• James Park
• Jamie H Park, D.D.S.
• Jee Son Park, PMHNP-BC
• Jin Hyuk Park, M.D.

• Clinical Social Worker in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.