Provider Demographics
NPI:1700619954
Name:GOODE-GREEN, DESIREE Y (MS, CNS, LDN)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:Y
Last Name:GOODE-GREEN
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W BEL AIR AVE UNIT 975
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-7541
Mailing Address - Country:US
Mailing Address - Phone:443-876-2708
Mailing Address - Fax:
Practice Address - Street 1:30 W BEL AIR AVE UNIT 975
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-7541
Practice Address - Country:US
Practice Address - Phone:443-876-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6809133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education