Healthcare Provider Details

I. General information

NPI: 1538241336
Provider Name (Legal Business Name): KELURAH A COMILANG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE AMERICA BUILDING ROOM 6437
BETHESDA MD
20889-2600
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE AMERICA BUILDING (19) RM 6437
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-1407
  • Fax:
Mailing address:
  • Phone: 301-335-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04274
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number04274
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number04274
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number04274
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number04274
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04274
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: