Healthcare Provider Details

I. General information

NPI: 1437243276
Provider Name (Legal Business Name): AMBER DAWN CAUBLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 TUOLUMNE ST STE 3400
VALLEJO CA
94590-5700
US

IV. Provider business mailing address

2101 COURAGE DR STE 101
FAIRFIELD CA
94533-6717
US

V. Phone/Fax

Practice location:
  • Phone: 707-553-5302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: