Healthcare Provider Details

I. General information

NPI: 1386744555
Provider Name (Legal Business Name): STEPHANIE TIERNEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2269 SAW MILL RIVER RD BUILDING 1A
ELMSFORD NY
10523-3832
US

IV. Provider business mailing address

2 BRYANT CRES 1F
WHITE PLAINS NY
10605-2638
US

V. Phone/Fax

Practice location:
  • Phone: 914-345-5900
  • Fax: 914-347-8859
Mailing address:
  • Phone: 914-345-5900
  • Fax: 914-347-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR056201-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: