Provider Demographics
NPI:1215124193
Name:GERAY, OMAR ALI (LCSW)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:ALI
Last Name:GERAY
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 1:6016 AFTON CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2601
Mailing Address - Country:US
Mailing Address - Phone:408-622-8274
Mailing Address - Fax:
Practice Address - Street 1:6016 AFTON CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2601
Practice Address - Country:US
Practice Address - Phone:408-622-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297261041C0700X
CALCSW297261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical