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General NPI Number Information
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NPI Number | 1942415492
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Entity Type | Individual
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Provider Name | STACI R. EMERSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 419 N LARCHMONT BLVD # 139
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City | LOS ANGELES
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State | CA
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Zip | 90004-3013
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Country | US
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Telephone | 310-225-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 5469 E ANAHEIM RD
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City | LONG BEACH
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State | CA
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Zip | 90815-4324
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Country | US
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Telephone | 310-225-5220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY16661
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License Number State | CA
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