MEDICARE: ROBERT S GORELIK LCSW

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	1041C0700X	Clinical Social Worker	1373693501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	292735	OTHER	UT	DESERET MUTUAL INSURANCE
2	942938348GO1	OTHER	UT	EDUCATORS MUTUAL
3	107000923101	OTHER	UT	INTERMOUNTIAN HEALTH CARE

General Provider Information

NPI Number	:	1548345408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT S GORELIK LCSW

Provider Business Mailing Address
First Line	:	8834 GORGOZA DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4734
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8834 GORGOZA DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4734
Country	:	US
Telephone Number	:	435-645-9336
Fax Number	:

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	04/23/2008

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