Provider Demographics
NPI:1215562871
Name:TIERNO, NICOLE (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TIERNO
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1362
Mailing Address - Country:US
Mailing Address - Phone:631-708-7795
Mailing Address - Fax:
Practice Address - Street 1:247 MAIN ST UNIT 201
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2727
Practice Address - Country:US
Practice Address - Phone:631-708-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003189-1101YM0800X
NJ37PC00711500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health