Provider Demographics
NPI:1548345408
Name:GORELIK, ROBERT S (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:GORELIK
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 1:8834 GORGOZA DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8834 GORGOZA DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-4734
Practice Address - Country:US
Practice Address - Phone:435-645-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13736935011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT292735OtherDESERET MUTUAL INSURANCE
UT942938348GO1OtherEDUCATORS MUTUAL
UT107000923101OtherINTERMOUNTIAN HEALTH CARE
UT$$$$$$$$$00001OtherBLUE CROSS