Provider Demographics
NPI:1700618469
Name:MARTHA TIERNEY LCSW LLC
Entity type:Organization
Organization Name:MARTHA TIERNEY LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA T
Authorized Official - Middle Name:
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-720-6136
Mailing Address - Street 1:2530 W IOWA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7249
Mailing Address - Country:US
Mailing Address - Phone:555-555-1212
Mailing Address - Fax:
Practice Address - Street 1:2530 W IOWA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7249
Practice Address - Country:US
Practice Address - Phone:555-555-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty