Healthcare Provider Details

I. General information

NPI: 1093638397
Provider Name (Legal Business Name): TIERNEY GREENE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CITY AVE STE 104
BALA CYNWYD PA
19004-1724
US

IV. Provider business mailing address

1918 E DAUPHIN ST APT 1F
PHILADELPHIA PA
19125-1506
US

V. Phone/Fax

Practice location:
  • Phone: 484-202-0751
  • Fax:
Mailing address:
  • Phone: 862-268-4037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW141225
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: