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General NPI Number Information
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NPI Number | 1598224941
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Entity Type | Individual
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Provider Name | ELAINE MARIE SUPRANO LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1792 BEAR CREEK PIKE
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City | COLUMBIA
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State | TN
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Zip | 38401-7653
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Country | US
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Telephone | 256-452-1404
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Fax |
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Provider Business Mailing Address
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Address Line | 84 EASTWOOD DR
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City | ANNISTON
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State | AL
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Zip | 36207-9303
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Country | US
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Telephone | 256-452-1404
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6606
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4033C
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License Number State | AL
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