Healthcare Provider Details

I. General information

NPI: 1467066019
Provider Name (Legal Business Name): JENNY SOVANRY MUK MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 GREENWAY CENTER DR STE 1300
GREENBELT MD
20770-3575
US

IV. Provider business mailing address

1911 D ST NE
WASHINGTON DC
20002-6719
US

V. Phone/Fax

Practice location:
  • Phone: 240-837-4945
  • Fax:
Mailing address:
  • Phone: 562-760-4668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: