MEDICARE: C AMBER ROSE DULLEA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L15948	OR

General Provider Information

NPI Number	:	1699498394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C AMBER ROSE DULLEA LCSW

Provider Business Mailing Address
First Line	:	9159 NW EGRET ST
Second Line	:
City	:	SEAL ROCK
State	:	OR
Zip	:	97376-9709
Country	:	US
Telephone Number	:	503-810-4163
Fax Number	:

Provider Business Practice Location Address
First Line	:	5693 NW PACIFIC COAST HWY
Second Line	:
City	:	SEAL ROCK
State	:	OR
Zip	:	97376-9638
Country	:	US
Telephone Number	:	503-810-4163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	12/24/2024

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