MEDICARE: STACY HAMILTON GILL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904001853	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110313	OTHER	VA	ANTHEM
2	2169350	OTHER	VA	MAMSI
3	263152-000	OTHER	VA	MAGELLAN
4	O85712	OTHER	VA	OPTIMA

General Provider Information

NPI Number	:	1871635904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY HAMILTON GILL LCSW

Provider Business Mailing Address
First Line	:	2728 PARVIEW WAY
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-7470
Country	:	US
Telephone Number	:	804-516-5137
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 LIBBIE AVE STE 1
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2658
Country	:	US
Telephone Number	:	804-516-5137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	05/19/2025

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