Healthcare Provider Details

I. General information

NPI: 1760347215
Provider Name (Legal Business Name): DARRYN TIERNEY LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ROUTE 34 STE 106
COLTS NECK NJ
07722-2444
US

IV. Provider business mailing address

18 CIVIC CENTER DR APT 5
EAST BRUNSWICK NJ
08816-3565
US

V. Phone/Fax

Practice location:
  • Phone: 732-648-6423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07295300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: