Healthcare Provider Details

I. General information

NPI: 1699498394
Provider Name (Legal Business Name): C AMBER ROSE DULLEA LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: AMBER ROSE DULLEA

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5693 NW PACIFIC COAST HWY
SEAL ROCK OR
97376-9638
US

IV. Provider business mailing address

9159 NW EGRET ST
SEAL ROCK OR
97376-9709
US

V. Phone/Fax

Practice location:
  • Phone: 503-810-4163
  • Fax:
Mailing address:
  • Phone: 503-810-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL15948
License Number StateOR

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: