Healthcare Provider Details

I. General information

NPI: 1548907884
Provider Name (Legal Business Name): RICARDO GREEN QMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 EUCLID AVE
EUCLID OH
44117-1521
US

IV. Provider business mailing address

1064 GREYTON RD
CLEVELAND OH
44112-3021
US

V. Phone/Fax

Practice location:
  • Phone: 216-859-2727
  • Fax:
Mailing address:
  • Phone: 216-322-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number188659
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: