Provider Demographics
NPI:1780296236
Name:MODY, SITAR DINESH (MA AMFT)
Entity type:Individual
Prefix:
First Name:SITAR
Middle Name:DINESH
Last Name:MODY
Suffix:
Gender:F
Credentials:MA AMFT
Other - Prefix:
Other - First Name:SITAR
Other - Middle Name:
Other - Last Name:MODY SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA AMFT
Mailing Address - Street 1:PO BOX 27195
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-0195
Mailing Address - Country:US
Mailing Address - Phone:510-213-8001
Mailing Address - Fax:
Practice Address - Street 1:614 GRAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3554
Practice Address - Country:US
Practice Address - Phone:510-433-0244
Practice Address - Fax:510-380-6525
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT109847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist