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General NPI Number Information
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NPI Number | 1700948320
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Entity Type | Individual
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Provider Name | MAUREEN TIERNEY RECE LCSW, ACSW
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 300 E HOSPITAL RD
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City | FORT GORDON
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State | GA
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Zip | 30905
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Country | US
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Telephone | 706-787-3656
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Fax | 706-787-8180
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Provider Business Mailing Address
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Address Line | 300 E HOSPITAL RD ROOM 13A-10
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City | FORT GORDON
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State | GA
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Zip | 30905-5650
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Country | US
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Telephone | 706-787-2720
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Fax | 706-787-8176
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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 | 001684
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License Number State | GA
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