| Green Road Behavioral Health, Inc. | |
|
1611 S Green Rd Ste 303 South Euclid OH 44121-4192 | |
| (216) 297-2053 | |
| (216) 297-2031 |
| Full Name | Green Road Behavioral Health, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1611 S Green Rd Ste 303, South Euclid, Ohio |
| Authorized Official Name and Position | Thomas Andrew Boyd (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 2162972053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Road Behavioral Health, Inc. 3295 Glencairn Rd Shaker Heights OH 44122-3407 Ph: (216) 702-5542 | Green Road Behavioral Health, Inc. 1611 S Green Rd Ste 303 South Euclid OH 44121-4192 Ph: (216) 297-2053 |
| NPI Number | 1750990537 |
|---|---|
| Provider Enumeration Date | 07/28/2020 |
| Last Update Date | 07/28/2020 |
| Certification Date | 07/28/2020 |
| Medicare PECOS PAC ID | 9234542234 |
|---|---|
| Medicare Enrollment ID | O20210112002972 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750990537 | NPI | - | NPPES |
| 0681169 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Thomas A Boyd |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871515262 PECOS PAC ID: 3971605155 Enrollment ID: I20070219000106 |
| Provider Name | Heidi Llisw Tolchinsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508368481 PECOS PAC ID: 6901219906 Enrollment ID: I20210112003304 |
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