Healthcare Provider Details

I. General information

NPI: 1659697258
Provider Name (Legal Business Name): JENNIFER URBAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6456 NEW TAYLOR RD
ORCHARD PARK NY
14127-2358
US

IV. Provider business mailing address

6456 NEW TAYLOR RD
ORCHARD PARK NY
14127-2358
US

V. Phone/Fax

Practice location:
  • Phone: 716-435-4320
  • Fax: 716-929-8940
Mailing address:
  • Phone: 716-435-4320
  • Fax: 716-906-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR057766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: