Individual provider Active NPI

Adam F. Vilmont, LISW

  • Clinical Social Worker
  • Davenport, IA
National Provider Identifier
1366903874
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
085401 Issued in IA
Practice address
2711 W 63Rd St Ste 3
Davenport, IA 52806-1647
Phone
(563) 388-1039
Fax
(563) 388-1014
NPI assigned
Mar 27, 2019
Last updated
Apr 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 085401 IA Primary

Addresses

Primary practice location

2711 W 63Rd St Ste 3
Davenport, IA 52806-1647

Mailing address

2711 W 63Rd St
Davenport, IA 52806-1647
Phone (563) 388-1039

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Previously, effective Sep 6, 2024 through Sep 6, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
085401IAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Centered Counseling Services, LLC. CurrentSince Apr 14, 2024 Accepting new patients

Locations

2711 W 63rd St
Davenport, IA 52806
Phone (563) 359-1455

2711 W 63rd St
Ste 3
Davenport, IA 52806
Phone (563) 388-1039

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1366903874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2711 W 63RD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528061647",
            "telephone_number": "563-388-1039",
            "fax_number": "563-388-1014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2711 W 63RD ST STE 3",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528061647",
            "telephone_number": "563-388-1039",
            "fax_number": "563-388-1014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILMONT",
        "first_name": "ADAM",
        "middle_name": "F.",
        "name_prefix": "Mr.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-27",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "085401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.