MEDICARE: KRISTINA MARIE MODESTE LMFT

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	106H00000X	Marriage & Family Therapist	160737	CA
2	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1831852011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MARIE MODESTE LMFT

Provider Business Mailing Address
First Line	:	3220 SACRAMENTO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2726
Country	:	US
Telephone Number	:	669-234-8196
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 SACRAMENTO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2726
Country	:	US
Telephone Number	:	669-234-8196
Fax Number	:

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

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	01/07/2026

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