Individual provider Active NPI

Emily Cetanyan, LSW

  • Clinical Social Worker
  • Moline, IL
National Provider Identifier
1871377226
Registry record updated Apr 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
150.117189 Issued in IL
Practice address
4600 3Rd St
Moline, IL 61265-6106
Phone
(563) 779-2082
NPI assigned
Aug 24, 2023
Last updated
Apr 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2026

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 150.117189 IL Primary

Addresses

Primary practice location

4600 3Rd St
Moline, IL 61265-6106

Mailing address

4600 3Rd St
Moline, IL 61265-6106
Phone (309) 779-2082

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20260107003484 IL Practitioner - Clinical Social Worker 2961988167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1776 W Lakes Pkwy
West Des Moines, IA 50266-8378

PO Box
Kansas City, MO 64184

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
150.117189ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Robert Young Center for Community Mental Health CurrentSince Oct 31, 2025 Accepting new patients
The Robert Young Center for Community Mental Health CurrentSince Oct 31, 2025 Accepting new patients

Locations

4600 3rd St
Moline, IL 61265
Phone (309) 779-2022

2560 24th St
Ste 101
Rock Island, IL 61201
Phone (309) 779-3970

Organizations & group practices 3

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": "1692835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776988800000",
    "number": "1871377226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 3RD ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656106",
            "telephone_number": "309-779-2082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 3RD ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656106",
            "telephone_number": "563-779-2082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CETANYAN",
        "first_name": "EMILY",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-24",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "150.117189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

Verify at the official NPI Registry.