Individual provider Active NPI

Kristina Heisser, MA

  • Marriage & Family Therapist
  • San Mateo, CA
National Provider Identifier
1982374252
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
AMFT141578 Issued in CA
Practice address
1108 S El Camino Real
San Mateo, CA 94402-2804
Phone
(650) 458-0026
NPI assigned
Sep 17, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X CA
Marriage & Family Therapist 106H00000X AMFT141578 CA Primary

Addresses

Primary practice location

1108 S El Camino Real
San Mateo, CA 94402-2804

Mailing address

1108 S El Camino Real
San Mateo, CA 94402-2804
Phone (650) 458-0026

Other practice location 1

21 Rancho Camino Dr
Pomona, CA 91766-7019
Phone (855) 223-7123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
AMFT141578CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Felton Institute PastSince Oct 29, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1982374252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 S EL CAMINO REAL",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022804",
            "telephone_number": "650-458-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 S EL CAMINO REAL",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022804",
            "telephone_number": "650-458-0026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 Rancho Camino Dr",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917667019",
            "country_code": "US",
            "telephone_number": "855-223-7123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEISSER",
        "first_name": "KRISTINA",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-17",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "AMFT141578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.