R. Lawrence Deroo, MS
Individual provider Active NPI Clinical Social Worker · Madison, WI
NPI 1649335993 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1649335993
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 2210-123 (WI)
- Practice address
- 700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2479 - Phone
- (608) 276-9191
- Fax
- (608) 276-9144
- NPI assigned
- Dec 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2210-123 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peter C. Jackson, PSYD Consulting, SC | Past |
Accepting new patients | |
| Family Therapy Center of Madison, Inc. | Clinical | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2210-123 | WI | Yes |
Addresses
Primary practice location
700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2479
Mailing address
700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2479
Phone (608) 276-9191
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39596200 | Medicaid | WI |
Other providers in Madison, WI
- Mackenzie N Mosera Derby
- Samantha Paige Dergai
- Jessica L Derks
- Abigail Deroche
- Elise Patricia Deroo
- Rachel Marie Deroos
- Ryan Michael Derose
- Penny K Derringer
- Ashley Derry
- Jodie Lynn Deruyter
All providers in Madison, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.