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General NPI Number Information
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NPI Number | 1104637628
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Entity Type | Individual
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Provider Name | RENEE E SUPERS LSW
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 22540 LORAIN RD
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-2212
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Country | US
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Telephone | 440-734-4037
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Fax |
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Provider Business Mailing Address
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Address Line | 310 CANTERBURY LN APT A
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City | MEDINA
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State | OH
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Zip | 44256-4033
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Country | US
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Telephone | 330-321-2018
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.0030839
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License Number State | OH
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