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General NPI Number Information
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NPI Number | 1932256062
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Entity Type | Individual
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Provider Name | GARY DEAN ZOMALT LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2512 W SCOTT AVE
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City | FRESNO
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State | CA
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Zip | 93711-2756
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Country | US
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Telephone | 559-435-2628
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Fax | 559-261-1436
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Provider Business Mailing Address
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Address Line | 5132 N PALM AVE # 196
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City | FRESNO
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State | CA
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Zip | 93704-2203
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Country | US
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Telephone | 559-289-9890
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Fax | 559-261-1436
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 12151
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License Number State | CA
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