Provider Demographics
NPI:1114461662
Name:TIERNEY, MARGARET (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 L ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4213
Mailing Address - Country:US
Mailing Address - Phone:315-345-2891
Mailing Address - Fax:
Practice Address - Street 1:204 L ST APT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-4213
Practice Address - Country:US
Practice Address - Phone:315-345-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1053103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst