Provider Demographics
NPI:1396721536
Name:BARTH, ROBERT GUSTAV (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GUSTAV
Last Name:BARTH
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 1:7434 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2014
Mailing Address - Country:US
Mailing Address - Phone:801-566-4423
Mailing Address - Fax:
Practice Address - Street 1:7434 S STATE ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2014
Practice Address - Country:US
Practice Address - Phone:801-566-4423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT502948135011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00310307OtherRAILROAD MEDICARE
UT50294813500001OtherBLUE CROSS
UT885122OtherDESERET MUTUAL
UTQ41206OtherMEDICARE ADVANTAGE PLANS
UT107031260101OtherINTRMTN. HEALTH CARE
UT94293834BRBOtherEDUCATORS MUTUAL
UTU000076256OtherVALLEY MENTAL HEALTH
UT885122OtherDESERET MUTUAL
Q41206Medicare UPIN