Provider Demographics
NPI:1831298991
Name:TIEN, STEPHEN S (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:TIEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 WYCKOFF RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-2344
Mailing Address - Country:US
Mailing Address - Phone:607-257-5008
Mailing Address - Fax:
Practice Address - Street 1:518 WYCKOFF RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2344
Practice Address - Country:US
Practice Address - Phone:607-257-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009632103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist