Provider Demographics
NPI:1265656128
Name:TIERNEY, ANNE O (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:O
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 DOOMAR DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4805
Mailing Address - Country:US
Mailing Address - Phone:850-671-2823
Mailing Address - Fax:
Practice Address - Street 1:1909 DOOMAR DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4805
Practice Address - Country:US
Practice Address - Phone:850-671-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 89101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179802701Medicaid
TX155184801Medicaid