Provider Demographics
NPI:1265161160
Name:TIERNEY, RACHEL POTTER BROWN (LMSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:POTTER BROWN
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1109
Mailing Address - Country:US
Mailing Address - Phone:734-546-9372
Mailing Address - Fax:
Practice Address - Street 1:111 MADISON ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1109
Practice Address - Country:US
Practice Address - Phone:734-546-9372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0616961041C0700X
MI68010791491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical