Provider Demographics
NPI:1396557922
Name:BRICK SKIBINSKI, JENNA NOEL
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:NOEL
Last Name:BRICK SKIBINSKI
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 1:3781 MCKOON AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1909
Mailing Address - Country:US
Mailing Address - Phone:716-251-9969
Mailing Address - Fax:
Practice Address - Street 1:630 66TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2212
Practice Address - Country:US
Practice Address - Phone:716-286-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113623104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker