Healthcare Provider Details

I. General information

NPI: 1932256062
Provider Name (Legal Business Name): GARY DEAN ZOMALT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 W SCOTT AVE
FRESNO CA
93711-2756
US

IV. Provider business mailing address

5132 N PALM AVE # 196
FRESNO CA
93704-2203
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-2628
  • Fax: 559-261-1436
Mailing address:
  • Phone: 559-289-9890
  • Fax: 559-261-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 12151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: