Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dereik Lance Domerese, LCSW

Individual provider Clinical Social Worker · NPI 1760927586

Dereik Lance Domerese, LCSW is a Clinical Social Worker in Lees Summit, Missouri. Licensed in Kansas and Missouri. Registered with an NPI since 2017.

Licensed in
KS, MO
In the registry since
2017
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

905 NE Rice Rd Ste B
Lees Summit, MO 64086-6300
Phone: (816) 223-8522
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 2016034259 (MO)
Clinical Social Worker Taxonomy 1041C0700X · Licence 10198 (KS)

Record details

NPI number1760927586
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorNo
NPI enumeratedJanuary 3, 2017
Last updated in NPPESJune 15, 2022
Certification dateJune 15, 2022

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