MEDICARE: MANY ROADS CLINIC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1407565674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANY ROADS CLINIC

Provider Business Mailing Address
First Line	:	2510 E CAPITOL DR
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2136
Country	:	US
Telephone Number	:	414-975-8106
Fax Number	:

Provider Business Practice Location Address
First Line	:	385 WILLIAMSTOWNE STE 105
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2323
Country	:	US
Telephone Number	:	414-975-8106
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/FOUNDER
Name	:	JOSEPH GRECO
Credential	:
Telephone Number	:	414-975-8106

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	11/16/2022

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Directions to “MANY ROADS CLINIC ” Practice Location

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