Healthcare Provider Details

I. General information

NPI: 1093643439
Provider Name (Legal Business Name): DR. STACI WOLD PSYCHOLOGICAL SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 BALBOA BLVD STE 212
ENCINO CA
91316-1517
US

IV. Provider business mailing address

6345 BALBOA BLVD STE 212
ENCINO CA
91316-1517
US

V. Phone/Fax

Practice location:
  • Phone: 818-968-1215
  • Fax:
Mailing address:
  • Phone: 818-968-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: STACI WOLD
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 818-968-1215