Healthcare Provider Details

I. General information

NPI: 1962091280
Provider Name (Legal Business Name): MARY HODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1773 ABERDEEN CIR
CROFTON MD
21114-1635
US

IV. Provider business mailing address

1773 ABERDEEN CIR
CROFTON MD
21114-1635
US

V. Phone/Fax

Practice location:
  • Phone: 240-548-0694
  • Fax:
Mailing address:
  • Phone: 240-548-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76254
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: