Provider Demographics
NPI:1093856098
Name:TIERNEY, BRIAN WILLIAM (PHD, LP, RCST, CMT)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:TIERNEY
Suffix:
Gender:
Credentials:PHD, LP, RCST, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 CHERRYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1219
Mailing Address - Country:US
Mailing Address - Phone:510-541-8680
Mailing Address - Fax:
Practice Address - Street 1:20688 4TH ST # 4
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5894
Practice Address - Country:US
Practice Address - Phone:510-541-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46651225700000X
CAPSY31502103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty