Provider Demographics
NPI:1184688012
Name:BARRERA, RENE
Entity type:Individual
Prefix:MR
First Name:RENE
Middle Name:
Last Name:BARRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11939 COPPER MINE DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7728
Mailing Address - Country:US
Mailing Address - Phone:801-446-7426
Mailing Address - Fax:801-542-7061
Practice Address - Street 1:7370 CREEK RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6107
Practice Address - Country:US
Practice Address - Phone:801-542-7060
Practice Address - Fax:801-542-7061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool