Provider Demographics
NPI:1073957809
Name:MUSENGO, LIZ (BCBA, LBA, MED)
Entity type:Individual
Prefix:MS
First Name:LIZ
Middle Name:
Last Name:MUSENGO
Suffix:
Gender:
Credentials:BCBA, LBA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 KINGSTOWNE CTR STE 921
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5732
Mailing Address - Country:US
Mailing Address - Phone:833-747-4222
Mailing Address - Fax:
Practice Address - Street 1:5810 KINGSTOWNE CTR STE 9215810
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5732
Practice Address - Country:US
Practice Address - Phone:833-747-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-19-38285103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst