Tara Deroo LLC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801081584 Issued in MI

Legal business name

TARA DEROO LLC

Practice address

4127 Embassy Dr SE
Grand Rapids, MI 49546-2418

Phone

(616) 264-3200

Fax

(616) 264-3201

NPI assigned

Mar 7, 2013

Last updated

Mar 7, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tara Deroo, LMSWNPI 1205134194

Title

Social Worker

Phone

(616) 264-3200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tara Lee Deroo, LMSW

  • Clinical Social Worker
  • Zeeland, MI
  • NPI 1205134194
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1306187802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4127 EMBASSY DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462418",
            "telephone_number": "616-264-3200",
            "fax_number": "616-264-3201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4127 EMBASSY DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462418",
            "telephone_number": "616-264-3200",
            "fax_number": "616-264-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TARA DEROO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-07",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "DEROO",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "SOCIAL WORKER",
        "authorized_official_telephone_number": "616-264-3200",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801081584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Angelina Jatzil Tapia
• Maria Liberato Tappan, LMSW
• Megan A Taratuta, P.A.
• Bogna Irena Targonska, M.D.
• Lauren Anne Tarkiewicz, LMSW
• Emily R Tarnaski
• Amy Jo Tarpley, LLMSW

• Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.