Institute for Behavioral Change, Inc.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

1652 Issued in DC

Legal business name

INSTITUTE FOR BEHAVIORAL CHANGE, INC.

Practice address

2670 Crain Hwy Ste 205
Waldorf, MD 20601-2816

Phone

(301) 818-0092

Fax

(301) 818-0110

NPI assigned

Mar 3, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Howard Mabry, PHDNPI 1407328446

Title

Ceo

Phone

(301) 818-0110

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Tax ID family

Ibc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Institute for Behavioral Change, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Waldorf, MD
  • NPI 1225731235
  NPD tax ID
• Institute for Behavioral Change, Inc.

  • Mental Health Counselor
  • Waldorf, MD
  • NPI 1750084554
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Howard Mabry, PH D PSYCHOLOGIST

  • Psychologist
  • Washington, DC
  • NPI 1407328446

  MD

  Medicare reassignment NPD Authorized official
• Tamantha Demetrius Golden-Harper, ED.D., LGPC

  • Professional Counselor
  • Waldorf, MD
  • NPI 1558143800
  NPD (past)
• Natalie Hart

  • Psychiatric/Mental Health Registered Nurse
  • Baltimore, MD
  • NPI 1851553911
  NPD (past)
• Brittany A Young, LCSW-C

  • Social Worker
  • Waldorf, MD
  • NPI 1144683590
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1124298484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 CRAIN HWY STE 205",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012816",
            "telephone_number": "301-818-0092",
            "fax_number": "301-818-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2670 CRAIN HWY STE 205",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012816",
            "telephone_number": "301-818-0092",
            "fax_number": "301-818-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR BEHAVIORAL CHANGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-03",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "MABRY",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-818-0110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "DC",
            "license": "103000A-DT-Y-068",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "DC",
            "license": "1652",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC301420",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Child & Adolescent Psychologist in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Clinical Child & Adolescent Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.