Provider Demographics
NPI:1427588839
Name:CALDERA, AMBER (LCSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:CALDERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 N VANCOUVER WAY # 5166
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7530
Mailing Address - Country:US
Mailing Address - Phone:503-217-4030
Mailing Address - Fax:503-961-7166
Practice Address - Street 1:101 E 8TH ST STE 110
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3294
Practice Address - Country:US
Practice Address - Phone:503-217-4030
Practice Address - Fax:503-961-7166
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR109011041C0700X, 1041C0700X
104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool