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General NPI Number Information
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NPI Number | 1578842142
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Entity Type | Individual
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Provider Name | MARTHA CHRISTINE TIERNEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE 510
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City | CHICAGO
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State | IL
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Zip | 60601-7511
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Country | US
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Telephone | 612-720-6136
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Fax |
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Provider Business Mailing Address
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Address Line | 6033 N SHERIDAN RD STE S7
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City | CHICAGO
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State | IL
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Zip | 60660-3013
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Country | US
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Telephone | 855-264-9355
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.013957
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License Number State | IL
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