Provider Demographics
NPI:1376680892
Name:BONA, STACEY RHODES (PSYD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:RHODES
Last Name:BONA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:RHODES
Other - Last Name:BRICKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:6442 PLATT AVE # 1507
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3216
Mailing Address - Country:US
Mailing Address - Phone:747-288-8505
Mailing Address - Fax:
Practice Address - Street 1:22020 CLARENDON ST STE 208
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6322
Practice Address - Country:US
Practice Address - Phone:747-288-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical