Provider Demographics
NPI:1699816959
Name:MCTIERNAN, CATHERINE M (MS SPED)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:MCTIERNAN
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KNIGHT LANE
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2016
Mailing Address - Country:US
Mailing Address - Phone:631-979-2069
Mailing Address - Fax:
Practice Address - Street 1:14 KNIGHT LN
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2016
Practice Address - Country:US
Practice Address - Phone:631-979-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor