Active NPI
Stacy Gillen, LCSW-C
- Clinical Social Worker
- Annapolis, MD
National Provider Identifier
1891100467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 18944
- Practice address
- 108 Old Solomons Island Rd Ste a
Annapolis, MD 21401-0920 - Phone
- (443) 214-5097
- NPI assigned
- Jun 23, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 18944 | MD | Primary |
Addresses
Primary practice location
108 Old Solomons Island Rd Ste a
Annapolis, MD 21401-0920
Mailing address
185 Admiral Cochrane Dr Ste 120
Annapolis, MD 21401-7600
Phone (443) 440-5788
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 222423200 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18944 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682380800000",
"number": "1891100467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "185 ADMIRAL COCHRANE DR STE 120",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214017600",
"telephone_number": "443-440-5788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 OLD SOLOMONS ISLAND RD STE A",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214010920",
"telephone_number": "443-214-5097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLEN",
"first_name": "STACY",
"credential": "LCSW-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-23",
"last_updated": "2023-04-25",
"certification_date": "2023-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "18944",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "222423200",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Annapolis, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.