Healthcare Provider Details

I. General information

NPI: 1780229542
Provider Name (Legal Business Name): DESEREE NICOLE HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESEREE NICOLE MAIETTA

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 GODDARD PKWY STE D
SALISBURY MD
21801-1126
US

IV. Provider business mailing address

209 WALNUT ST
POCOMOKE CITY MD
21851-1423
US

V. Phone/Fax

Practice location:
  • Phone: 443-978-6020
  • Fax:
Mailing address:
  • Phone: 240-329-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA1423
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: