Provider Demographics
NPI:1821841164
Name:PETERSON, TIERANY MARIE (BSW)
Entity Type:Individual
Prefix:MS
First Name:TIERANY
Middle Name:MARIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 HODGES ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-1607
Mailing Address - Country:US
Mailing Address - Phone:901-273-3838
Mailing Address - Fax:
Practice Address - Street 1:208 MCCORD HALL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-3330
Practice Address - Country:US
Practice Address - Phone:901-273-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker