Provider Demographics
NPI:1992499107
Name:GEBRIL, OMR (MA)
Entity type:Individual
Prefix:
First Name:OMR
Middle Name:
Last Name:GEBRIL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:OMAR
Other - Middle Name:
Other - Last Name:GEBRIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:32 REEDSDALE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2906
Mailing Address - Country:US
Mailing Address - Phone:203-988-2016
Mailing Address - Fax:
Practice Address - Street 1:100 HANCOCK ST FL 9
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1745
Practice Address - Country:US
Practice Address - Phone:617-410-9328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health