Provider Demographics
NPI:1578893681
Name:SUPRINA, JOFFREY SCOTT (LMHC PHD)
Entity Type:Individual
Prefix:DR
First Name:JOFFREY
Middle Name:SCOTT
Last Name:SUPRINA
Suffix:
Gender:M
Credentials:LMHC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 W MARION AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4435
Mailing Address - Country:US
Mailing Address - Phone:941-205-2417
Mailing Address - Fax:941-205-2422
Practice Address - Street 1:992 TAMIAMI TRL
Practice Address - Street 2:GRAND OAK PLAZA SUITE B
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3868
Practice Address - Country:US
Practice Address - Phone:941-889-7800
Practice Address - Fax:941-889-7796
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health