Healthcare Provider Details

I. General information

NPI: 1265045900
Provider Name (Legal Business Name): AMBER M. ROTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 BLUFF ST
BOULDER CO
80301-2179
US

IV. Provider business mailing address

3303 BLUFF ST UNIT 331
BOULDER CO
80301-2198
US

V. Phone/Fax

Practice location:
  • Phone: 720-743-0367
  • Fax:
Mailing address:
  • Phone: 720-743-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09929182
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: