MEDICARE: DR. OMAR GAMAL REID PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1209	MA
2	103TC2200X	Clinical Child & Adolescent Psychologist	456	MA
3	103TS0200X	School Psychologist		MA
4	103TS0200X	School Psychologist		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0027092100	OTHER	MA	AETNA
2	365360	OTHER	MA	MAGELLAN
3	000000023252	OTHER	MA	BMC HEALTHNET
4	1028430	OTHER	MA	NHP
5	009133	OTHER	MA	HARVARD PILGRIM PBH UBH
6	463577	OTHER	MA	TUFTS HEALTH PLAN
7	LM0778	OTHER	MA	BLUE CROSS & BLUE SHIELD
8	1891324	OTHER	MA	MBHP

General Provider Information

NPI Number	:	1922212810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR GAMAL REID PSY.D

Provider Business Mailing Address
First Line	:	PO BOX 190781
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02119-0015
Country	:	US
Telephone Number	:	617-230-6158
Fax Number	:	617-825-7804

Provider Business Practice Location Address
First Line	:	895 BLUE HILL AVENUE
Second Line	:	1960 WASHINGTON STREET, ROXBURY, MA 02119
City	:	BOSTON
State	:	MA
Zip	:	02124
Country	:	US
Telephone Number	:	617-822-0829
Fax Number	:	617-825-7804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	09/11/2025

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