Provider Demographics
NPI:1790096410
Name:BARELA, MALETA ANNE (SSW)
Entity Type:Individual
Prefix:MS
First Name:MALETA
Middle Name:ANNE
Last Name:BARELA
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 W 4100 S
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-2685
Mailing Address - Country:US
Mailing Address - Phone:801-721-6231
Mailing Address - Fax:
Practice Address - Street 1:883 W 4100 S
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-2685
Practice Address - Country:US
Practice Address - Phone:801-721-6231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7273837-3503104100000X
UT72738373503253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No104100000XBehavioral Health & Social Service ProvidersSocial Worker