Provider Demographics
NPI:1760279038
Name:KOME, IVO EJELLE
Entity type:Individual
Prefix:
First Name:IVO
Middle Name:EJELLE
Last Name:KOME
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CLINTON HILL CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3678
Mailing Address - Country:US
Mailing Address - Phone:240-927-9151
Mailing Address - Fax:
Practice Address - Street 1:8 CLINTON HILL CT
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3678
Practice Address - Country:US
Practice Address - Phone:240-927-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool