Provider Demographics
NPI:1528620796
Name:TIERNEY, AMY SAFER (LCSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:SAFER
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:SAFER
Other - Last Name:THEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 WETSTONE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3664
Mailing Address - Country:US
Mailing Address - Phone:310-447-5841
Mailing Address - Fax:
Practice Address - Street 1:36 WETSTONE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3664
Practice Address - Country:US
Practice Address - Phone:310-447-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA956071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical