Provider Demographics
NPI:1922212810
Name:REID, OMAR GAMAL (PSYD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:GAMAL
Last Name:REID
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:GAMAL
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 190781
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-0015
Mailing Address - Country:US
Mailing Address - Phone:617-230-6158
Mailing Address - Fax:617-825-7804
Practice Address - Street 1:895 BLUE HILL AVENUE
Practice Address - Street 2:1960 WASHINGTON STREET, ROXBURY, MA 02119
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124
Practice Address - Country:US
Practice Address - Phone:617-822-0829
Practice Address - Fax:617-825-7804
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1209101YM0800X
MA456103TC2200X
MA103TS0200X
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0027092100OtherAETNA
MA365360OtherMAGELLAN
MA000000023252OtherBMC HEALTHNET
MA1028430OtherNHP
MA009133OtherHARVARD PILGRIM PBH UBH
MA463577OtherTUFTS HEALTH PLAN
MALM0778OtherBLUE CROSS & BLUE SHIELD
MA1891324OtherMBHP