Basic Information
| Provider Information | |||||||||
| NPI: | 1942777305 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLLABORATIVE COUNSELING TMS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLLABORATIVE COUNSELING TMS | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5560 STERRETT PL STE 201 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435461100 | ||||||||
| FaxNumber: | 4435464005 | ||||||||
| Practice Location | |||||||||
| Address1: | 5560 STERRETT PL STE 201 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435461100 | ||||||||
| FaxNumber: | 4435464005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2018 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | GREENBERGER | ||||||||
| AuthorizedOfficialFirstName: | BRETT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4435461100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1073591558 | 01 | MD | DR. BRETT GREENBERGER | OTHER | 1891946810 | 01 | MD | DR. CONSTANCE FLANAGAN | OTHER |