Connie S Williams, LISW-SUPV

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.0800334-SUPV Issued in OH

Practice address

302 W Main St
Fairborn, OH 45324-5037

Phone

(937) 281-4673

Fax

(937) 318-1120

NPI assigned

Nov 18, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

J Kilby Enterprises IncGroup PAC ID 7214302223, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• J. Kilby Enterprises, Inc.

  • Mental Health Counselor
  • Centerville, OH
  • NPI 1316652894
  Medicare reassignment Care Compare group
• Talbert House

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cincinnati, OH
  • NPI 1619900834
  Medicare reassignment NPD
• Decoach Team LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cincinnati, OH
  • NPI 1366992224
  NPD
• Decoach Team LLC

  • Adult Mental Health Clinic/Center
  • Cincinnati, OH
  • NPI 1578037552
  NPD

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1497737050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 DIXIE HWY",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450151653",
            "telephone_number": "513-892-4673",
            "fax_number": "513-737-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W MAIN ST",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453245037",
            "telephone_number": "937-281-4673",
            "fax_number": "937-318-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "CONNIE",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "LISW-SUPV",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-18",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "LSW S 0005246",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.0800334-SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2272231",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wickshire Fairborn Opco LLC
• Marie Wile
• Monique Lauren Wiley
• Darien E. Ramone Wilkerson, B.S
• Nicole Will
• Dezirae Williams
• James E Williams, AT
• Natajah Williams
• Charlotte S Williamson, COTA
• Kayla Willingham

• Clinical Social Worker in Fairborn, OH
• Providers in Fairborn, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.