Provider Demographics
NPI:1659697258
Name:URBAN, JENNIFER (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:URBAN
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 1:6456 NEW TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2358
Mailing Address - Country:US
Mailing Address - Phone:716-435-4320
Mailing Address - Fax:716-906-2809
Practice Address - Street 1:6456 NEW TAYLOR RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2358
Practice Address - Country:US
Practice Address - Phone:716-435-4320
Practice Address - Fax:716-929-8940
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0577661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical