MEDICARE: RIVER ROAD TMS, 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1962387225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER ROAD TMS, LLC

Provider Business Mailing Address
First Line	:	5101 MONUMENT AVE STE 204
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3253
Country	:	US
Telephone Number	:	804-406-4773
Fax Number	:	804-430-5645

Provider Business Practice Location Address
First Line	:	5101 MONUMENT AVE STE 204
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3253
Country	:	US
Telephone Number	:	804-406-4773
Fax Number	:	804-430-5645

Authorized Official
Title or Position	:	OWNER
Name	:	CARLEEN DIMEGLIO
Credential	:	NP
Telephone Number	:	703-517-3182

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	08/06/2025

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