C Amber Rose Dullea, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L15948 Issued in OR

Practice address

5693 NW Pacific Coast Hwy
Seal Rock, OR 97376-9638

Phone

(503) 810-4163

NPI assigned

Sep 19, 2022

Last updated

Dec 24, 2024By the provider in NPPES

Sex

Unspecified or another gender identity

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amber Rose Dullea Other name

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Jacobs Mental Health ServicesGroup PAC ID 0749721702, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacobs Mental Health Services

  dba Skycloud Mental Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Clackamas, OR
  • NPI 1407573850
  Medicare reassignment Care Compare group NPD
• Jacobs MH of Washington

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Issaquah, WA
  • NPI 1033910450
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734998400000",
    "number": "1699498394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9159 NW EGRET ST",
            "city": "SEAL ROCK",
            "state": "OR",
            "postal_code": "973769709",
            "telephone_number": "503-810-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5693 NW PACIFIC COAST HWY",
            "city": "SEAL ROCK",
            "state": "OR",
            "postal_code": "973769638",
            "telephone_number": "503-810-4163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DULLEA",
        "first_name": "C AMBER",
        "middle_name": "ROSE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2022-09-19",
        "last_updated": "2024-12-24",
        "certification_date": "2024-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L15948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMBER",
            "last_name": "DULLEA",
            "middle_name": "ROSE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michelle L Coates, LMT
• Sterling Evison, M.A., LMFT
• Christine Lacedra, RN

• Clinical Social Worker in Seal Rock, OR
• Providers in Seal Rock, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.