Healthcare Provider Details

I. General information

NPI: 1114869302
Provider Name (Legal Business Name): STEFANIE SUPENIA RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTHALL LN STE 207B
MAITLAND FL
32751-7478
US

IV. Provider business mailing address

2700 WESTHALL LN STE 207B
MAITLAND FL
32751-7478
US

V. Phone/Fax

Practice location:
  • Phone: 352-770-2422
  • Fax:
Mailing address:
  • Phone: 352-770-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1511339
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW23073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: