Active NPI
Marina Clarice Tierney, PSY.D.
- Psychologist
- Brookfield, WI
National Provider Identifier
1396858825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2459-057
- Practice address
- 12760 W North Ave BLDG a
Brookfield, WI 53005-4628 - Phone
- (262) 439-5500
- NPI assigned
- Aug 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2459-057 | WI | Primary |
Addresses
Primary practice location
12760 W North Ave BLDG a
Brookfield, WI 53005-4628
Mailing address
12760 W North Ave BLDG a
Brookfield, WI 53005-4628
Phone (262) 439-5500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43576000 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2009
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
12760 W N Ave
Brookfield, WI 53005-4628
Phone (262) 439-5500
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2459-057 | WI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lighthouse Clinic | Psychologist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatry Physician
- Brookfield, WI
- NPI 1588739155
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758672000000",
"number": "1396858825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12760 W NORTH AVE BLDG A",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530054628",
"telephone_number": "262-439-5500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12760 W NORTH AVE BLDG A",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530054628",
"telephone_number": "262-439-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIERNEY",
"first_name": "MARINA",
"middle_name": "CLARICE",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-17",
"last_updated": "2025-09-24",
"certification_date": "2025-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "2459-057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43576000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.