Provider Demographics
NPI:1841463775
Name:TIERNEY-GABLER, STACEY LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:TIERNEY-GABLER
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 1:315 SCHROON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-1411
Mailing Address - Country:US
Mailing Address - Phone:845-626-7444
Mailing Address - Fax:845-626-7444
Practice Address - Street 1:4 RODMANS LN
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5013
Practice Address - Country:US
Practice Address - Phone:845-626-7444
Practice Address - Fax:845-626-7444
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071456-1104100000X
NY21806281041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY071456-1OtherNYS OFFICE OF PROFESSIONS