NPIMap

Organization Active NPI

Change Reaction

  • Community/Behavioral Health Agency
  • Riverdale, MD
National Provider Identifier
1275201758
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CHANGE REACTION
Practice address
4404 Queensbury Rd Ste 105
Riverdale, MD 20737-1074
Phone
(240) 432-7659
Fax
(301) 864-1301
NPI assigned
Aug 31, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Authorized official

Name
Ms. Kimberly M GreenNPI 1164601787
Title
Owner/Program Manager
Phone
(301) 864-0919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

4404 Queensbury Rd Ste 105
Riverdale, MD 20737-1074

Mailing address

4404 Queensbury Rd Ste 105
Riverdale, MD 20737-1074
Phone (240) 432-7659

Other names 1

  • Change Reaction Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1275201758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4404 QUEENSBURY RD STE 105",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371074",
            "telephone_number": "240-432-7659",
            "fax_number": "301-864-1301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4404 QUEENSBURY RD STE 105",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371074",
            "telephone_number": "240-432-7659",
            "fax_number": "301-864-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE REACTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-08-31",
        "certification_date": "2021-07-23",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PROGRAM MANAGER",
        "authorized_official_telephone_number": "301-864-0919",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Change Reaction",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverdale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.