Healthcare Provider Details

I. General information

NPI: 1093856098
Provider Name (Legal Business Name): BRIAN WILLIAM TIERNEY PHD, LP, RCST, CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20688 4TH ST # 4
SARATOGA CA
95070-5894
US

IV. Provider business mailing address

2243 CHERRYSTONE DR
SAN JOSE CA
95128-1219
US

V. Phone/Fax

Practice location:
  • Phone: 510-541-8680
  • Fax:
Mailing address:
  • Phone: 510-541-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY31502
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number46651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: