Provider Demographics
NPI:1588782510
Name:TIERNEY, GEORGE PATRICK (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PATRICK
Last Name:TIERNEY
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 1:10 WILSEY SQUARE
Mailing Address - Street 2:SUITE 232
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3729
Mailing Address - Country:US
Mailing Address - Phone:201-652-5384
Mailing Address - Fax:201-847-2959
Practice Address - Street 1:10 WILSEY SQUARE
Practice Address - Street 2:SUITE 232
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3729
Practice Address - Country:US
Practice Address - Phone:201-652-5384
Practice Address - Fax:201-847-2959
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100151600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051015OtherVLAUE OPTIONS HMO
NY6800065OtherGHI HMO
KY169128OtherMANAGED HEALTH NETWORK
CA169128OtherMANAGED HEALTH NETWORK
NJ727103Medicare ID - Type Unspecified
NY727103Medicare ID - Type Unspecified