Healthcare Provider Details

I. General information

NPI: 1164574190
Provider Name (Legal Business Name): JENNIFER M SCHWENKBECK PH.D. , LCSW R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 MAIN ST
HAMBURG NY
14075-4915
US

IV. Provider business mailing address

4717 EDGEWOOD TER
EDEN NY
14057-9756
US

V. Phone/Fax

Practice location:
  • Phone: 716-238-1236
  • Fax:
Mailing address:
  • Phone: 716-238-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number028530-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0538141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: