Provider Demographics
NPI:1104049808
Name:LILENFELD, LISA (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:LILENFELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 BRANDING IRON CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2947
Mailing Address - Country:US
Mailing Address - Phone:703-526-5878
Mailing Address - Fax:703-243-8973
Practice Address - Street 1:1800 MICHAEL FARADAY DR
Practice Address - Street 2:SUITE 206
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5354
Practice Address - Country:US
Practice Address - Phone:703-526-5878
Practice Address - Fax:703-243-8973
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical