MEDICARE: GREENBROOK TMS CLEVELAND LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1417420456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBROOK TMS CLEVELAND LLC

Provider Business Mailing Address
First Line	:	PO BOX 950625
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-0625
Country	:	US
Telephone Number	:	855-711-4867
Fax Number	:	641-800-3145

Provider Business Practice Location Address
First Line	:	4807 ROCKSIDE RD STE 450
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2192
Country	:	US
Telephone Number	:	855-940-4867
Fax Number	:	855-721-4867

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	PATRICIA WILLET
Credential	:
Telephone Number	:	855-711-4867

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	05/26/2026

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