Healthcare Provider Details

I. General information

NPI: 1487081782
Provider Name (Legal Business Name): SARA LOUISE BLOMELING-DEROO LCSW,LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4157 OASIS AVE
SPRING HILL FL
34609-2243
US

IV. Provider business mailing address

5331 COMMERCIAL WAY STE 209
SPRING HILL FL
34606-1426
US

V. Phone/Fax

Practice location:
  • Phone: 616-298-4594
  • Fax: 616-298-4594
Mailing address:
  • Phone: 616-298-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089540
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13756
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: