MEDICARE: DR. STACY MONIQUE WADLINGTON PH.D.

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
1	103TC0700X	Clinical Psychologist	PSY 20509	CA

General Provider Information

NPI Number	:	1881773810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY MONIQUE WADLINGTON PH.D.

Provider Business Mailing Address
First Line	:	9171 WILSHIRE BLVD
Second Line	:	PENTHOUSE SUITE # 15
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9171 WILSHIRE BLVD
Second Line	:	PENTHOUSE SUITE # 15
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5530
Country	:	US
Telephone Number	:	323-692-7775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	11/11/2008

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