Provider Demographics
NPI:1417494113
Name:FARRY, TIERNEY (LPC, RYT)
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:
Last Name:FARRY
Suffix:
Gender:F
Credentials:LPC, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1310
Mailing Address - Country:US
Mailing Address - Phone:201-618-9326
Mailing Address - Fax:
Practice Address - Street 1:70 PARK ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-5907
Practice Address - Country:US
Practice Address - Phone:973-544-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00571800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health