Provider Demographics
NPI:1457819096
Name:ROBELLO, MALIA CAROLINE (MSW)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:CAROLINE
Last Name:ROBELLO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4927 NE GOING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2039
Mailing Address - Country:US
Mailing Address - Phone:971-570-2566
Mailing Address - Fax:
Practice Address - Street 1:11010 SE DIVISION ST # 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-6400
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker