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:
Practice Address - Street 1:1792 BEAR CREEK PIKE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-7653
Practice Address - Country:US
Practice Address - Phone:256-452-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66061041C0700X
AL4033C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6606OtherTENNESSEE LICENSE NUMBER