Provider Demographics
NPI:1720968936
Name:TIERS, SOPHIA RAY
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:RAY
Last Name:TIERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 BROADWAY STE 2125
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9228
Mailing Address - Country:US
Mailing Address - Phone:646-960-5186
Mailing Address - Fax:
Practice Address - Street 1:1412 BROADWAY STE 2125
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9228
Practice Address - Country:US
Practice Address - Phone:646-960-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health