| Greenbrook Tms St Louis, Llc | |
|
11477 Olde Cabin Rd Ste 210 Saint Louis MO 63141-7129 | |
| (855) 950-4867 | |
| Not Available |
| Full Name | Greenbrook Tms St Louis, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11477 Olde Cabin Rd Ste 210, Saint Louis, Missouri |
| Authorized Official Name and Position | Annie Farley (REGIONAL MANAGER) |
| Authorized Official Contact | 3147500966 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenbrook Tms St Louis, Llc 16091 Swingley Ridge Rd Ste 110 Chesterfield MO 63017-2024 Ph: (314) 750-0966 | Greenbrook Tms St Louis, Llc 11477 Olde Cabin Rd Ste 210 Saint Louis MO 63141-7129 Ph: (855) 950-4867 |
| NPI Number | 1144713884 |
|---|---|
| Provider Enumeration Date | 06/07/2018 |
| Last Update Date | 03/19/2024 |
| Certification Date | 03/19/2024 |
| Medicare PECOS PAC ID | 4284985417 |
|---|---|
| Medicare Enrollment ID | O20181105000980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144713884 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Steven Harvey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811007289 PECOS PAC ID: 2163449653 Enrollment ID: I20051024000893 |
| Provider Name | Jyothi Mandava |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891809539 PECOS PAC ID: 4284631672 Enrollment ID: I20061027000015 |
| Provider Name | Arturo C Taca |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295846319 PECOS PAC ID: 9739187683 Enrollment ID: I20061201000234 |
| Provider Name | Sanjeev Kamat |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649375288 PECOS PAC ID: 4385746767 Enrollment ID: I20070305000203 |
| Provider Name | Radhika Rao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952485708 PECOS PAC ID: 8921101015 Enrollment ID: I20070309000356 |
| Provider Name | Leticia B Ugarte |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306049515 PECOS PAC ID: 8921151044 Enrollment ID: I20090806000298 |
| Provider Name | Robert H Rifkin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639289051 PECOS PAC ID: 8628118494 Enrollment ID: I20091230000042 |
| Provider Name | Rachel Morel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568664159 PECOS PAC ID: 7810174174 Enrollment ID: I20110614000422 |
| Provider Name | Daniel A Loiterstein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225086671 PECOS PAC ID: 1254304561 Enrollment ID: I20120124000801 |
| Provider Name | Howard J Ilivicky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093711152 PECOS PAC ID: 0648417576 Enrollment ID: I20130513000277 |
| Provider Name | Matthew Charles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770913089 PECOS PAC ID: 4486884129 Enrollment ID: I20140225002284 |
| Provider Name | Abraham Medaris |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033422480 PECOS PAC ID: 3375769797 Enrollment ID: I20140721001841 |
| Provider Name | Pravesh Prabhu Deotale |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710275110 PECOS PAC ID: 2163660283 Enrollment ID: I20160708000233 |
| Provider Name | Faith Ann Caster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407310907 PECOS PAC ID: 2264771336 Enrollment ID: I20190307001016 |
| Provider Name | Kayla Marlene Gervich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538847058 PECOS PAC ID: 0446614317 Enrollment ID: I20230911002286 |
| Provider Name | Lauren Vaughan |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1174239511 PECOS PAC ID: 6608214879 Enrollment ID: I20240406000334 |
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