NPIMap

Organization Active NPI

Creative Change Therapy Center LLP

  • Clinical Social Worker
  • Silver Spring, MD
National Provider Identifier
1982862405
Registry record updated Sep 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
05659 Issued in MD
Legal business name
CREATIVE CHANGE THERAPY CENTER LLP
Practice address
10702 Lombardy Rd
Silver Spring, MD 20901-1631
Phone
(301) 754-0122
NPI assigned
May 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2009

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

Authorized official

Name
Mr. Kent Robert Beduhn, LCSW-CNPI 1083753354
Title
Partner
Phone
(301) 754-0122

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X 4026 MD
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 05659 MD Primary

Addresses

Primary practice location

10702 Lombardy Rd
Silver Spring, MD 20901-1631

Mailing address

10702 Lombardy Rd
Silver Spring, MD 20901-1631
Phone (301) 754-0122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090903000516 DC Part B Supplier - Clinic/Group Practice 8123173747 Receives reassigned benefits from 1 practitioner
Practice locations: Silver Spring, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251936000000",
    "number": "1982862405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10702 LOMBARDY RD",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209011631",
            "telephone_number": "301-754-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10702 LOMBARDY RD",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209011631",
            "telephone_number": "301-754-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE CHANGE THERAPY CENTER LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-30",
        "last_updated": "2009-09-03",
        "status": "A",
        "authorized_official_last_name": "BEDUHN",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "301-754-0122",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "4026",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "05659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silver Spring, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; 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.