Provider Demographics
NPI:1932256062
Name:ZOMALT, GARY DEAN (LCSW)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DEAN
Last Name:ZOMALT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 N PALM AVE
Mailing Address - Street 2:# 196
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2203
Mailing Address - Country:US
Mailing Address - Phone:559-289-9890
Mailing Address - Fax:559-261-1436
Practice Address - Street 1:2512 W SCOTT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2756
Practice Address - Country:US
Practice Address - Phone:559-435-2628
Practice Address - Fax:559-261-1436
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 121511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical