Provider Demographics
NPI:1235899725
Name:TIERNEY, MARY LOU (NBC-HWC)
Entity Type:Individual
Prefix:MS
First Name:MARY LOU
Middle Name:
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HESPERUS CIR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-5205
Mailing Address - Country:US
Mailing Address - Phone:617-447-0686
Mailing Address - Fax:
Practice Address - Street 1:5 HESPERUS CIR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5205
Practice Address - Country:US
Practice Address - Phone:617-447-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3387250