Provider Demographics
NPI:1942415492
Name:EMERSON, STACI R (PHD)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:R
Last Name:EMERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5469 E ANAHEIM RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4324
Mailing Address - Country:US
Mailing Address - Phone:310-225-5220
Mailing Address - Fax:
Practice Address - Street 1:419 N LARCHMONT BLVD # 139
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3013
Practice Address - Country:US
Practice Address - Phone:310-225-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16661103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical