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NPI Code Detail

MEDICARE: EMMADA PSYCHOLOGY CENTER

MEDICARE: EMMADA PSYCHOLOGY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1598606253
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMMADA PSYCHOLOGY CENTER
Provider Business Mailing Address
First Line : 8939 S SEPULVEDA BLVD STE 200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-3667
Country : US
Telephone Number : 855-255-9366
Fax Number :
Provider Business Practice Location Address
First Line : 8939 S SEPULVEDA BLVD STE 200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-3667
Country : US
Telephone Number : 855-255-9366
Fax Number :
Authorized Official
Title or Position : MANAGING PARTNER
Name : LISA BOLDEN
Credential : PSYD
Telephone Number : 310-626-0167
Provider Enumeration Date : 04/04/2026
Last Update Date : 04/20/2026

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Directions to “EMMADA PSYCHOLOGY CENTER ” Practice Location

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