Active NPI
Stacey Rhodes Bona, PSY.D
- Clinical Psychologist
- Woodland Hills, CA
National Provider Identifier
1376680892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18832
- Practice address
- 22020 Clarendon St Ste 208
Woodland Hills, CA 91367-6322 - Phone
- (747) 288-8505
- NPI assigned
- Feb 1, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18832 | CA | Primary |
Addresses
Primary practice location
22020 Clarendon St Ste 208
Woodland Hills, CA 91367-6322
Mailing address
6442 Platt Ave # 1507
West Hills, CA 91307-3216
Phone (747) 288-8505
Other names 1
- Dr. Stacey Rhodes Bricklin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 15, 2020 through Jan 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18832 | CA | MD | Clinical Psychologist |
| 18832 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1376680892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6442 PLATT AVE # 1507",
"city": "WEST HILLS",
"state": "CA",
"postal_code": "913073216",
"telephone_number": "747-288-8505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22020 CLARENDON ST STE 208",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913676322",
"telephone_number": "747-288-8505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONA",
"first_name": "STACEY",
"middle_name": "RHODES",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-01",
"last_updated": "2023-11-27",
"certification_date": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STACEY",
"last_name": "BRICKLIN",
"middle_name": "RHODES",
"prefix": "DR.",
"credential": "PSY.D",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Woodland Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.