Healthcare Provider Details

I. General information

NPI: 1669103479
Provider Name (Legal Business Name): ROBERT JAMES TIERNEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5000
  • Fax:
Mailing address:
  • Phone: 518-656-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: