Provider Demographics
NPI:1598224941
Name:SUPRANO, ELAINE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:SUPRANO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-9303
Mailing Address - Country:US
Mailing Address - Phone:256-452-1404
Mailing Address - Fax:256-760-0692
Practice Address - Street 1:303 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5709
Practice Address - Country:US
Practice Address - Phone:256-760-0200
Practice Address - Fax:256-760-0692
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4033C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6606OtherTENNESSEE LICENSE NUMBER