Healthcare Provider Details

I. General information

NPI: 1285163378
Provider Name (Legal Business Name): KOMILA DADAKHODJAEVA BRENNAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ALICEANNA ST
BALTIMORE MD
21202-4387
US

IV. Provider business mailing address

650 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-4318
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-7500
  • Fax:
Mailing address:
  • Phone: 410-929-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06048
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: