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

Organization subpart

No

Name

Mrs. Tara Deroo, LMSWNPI 1205134194

Title

Social Worker

Phone

(616) 264-3200

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tara Lee Deroo, LMSW

  • Clinical Social Worker
  • Zeeland, MI
  • NPI 1205134194

  MI

  Medicare reassignment Authorized official

Medicare fee-for-service enrollment

Enrolled in MI

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 7, 2013.

{
    "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

• All providers in Grand Rapids, MI
• 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.