Provider Demographics
NPI:1942950720
Name:VAGTS, TIERNEY (LCSW)
Entity type:Individual
Prefix:MS
First Name:TIERNEY
Middle Name:
Last Name:VAGTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ONEIDA LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-3708
Mailing Address - Country:US
Mailing Address - Phone:732-675-3233
Mailing Address - Fax:
Practice Address - Street 1:106 ONEIDA LAKE DR
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-3708
Practice Address - Country:US
Practice Address - Phone:732-675-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060584001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC06058400OtherLICENSED CLINICAL SOCIAL WORKER