Provider Demographics
NPI:1790384238
Name:AMY R DURYEA LCSW LLC
Entity Type:Organization
Organization Name:AMY R DURYEA LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DURYEA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-204-0100
Mailing Address - Street 1:2432 SW 35TH DR
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7862
Mailing Address - Country:US
Mailing Address - Phone:541-204-0100
Mailing Address - Fax:
Practice Address - Street 1:2432 SW 35TH DR
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7862
Practice Address - Country:US
Practice Address - Phone:541-204-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-24
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty