Provider Demographics
NPI:1487081782
Name:BLOMELING-DEROO, SARA LOUISE (LCSW,LMSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:BLOMELING-DEROO
Suffix:
Gender:F
Credentials:LCSW,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 COMMERCIAL WAY STE 209
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1426
Mailing Address - Country:US
Mailing Address - Phone:616-298-4594
Mailing Address - Fax:
Practice Address - Street 1:4157 OASIS AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-2243
Practice Address - Country:US
Practice Address - Phone:616-298-4594
Practice Address - Fax:616-298-4594
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010895401041C0700X
FLSW137561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical