MEDICARE: THE ODYSSEY FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	SW00003210	FL

General Provider Information

NPI Number	:	1174760912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ODYSSEY FOUNDATION INC

Provider Business Mailing Address
First Line	:	205 NE 5TH TER
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3866
Country	:	US
Telephone Number	:	561-276-0020
Fax Number	:	561-265-0333

Provider Business Practice Location Address
First Line	:	205 NE 5TH TER
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3866
Country	:	US
Telephone Number	:	561-276-0020
Fax Number	:	561-265-0333

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOTHERAPIST
Name	:	MRS. ELIZABETH ANNE CAPARROS
Credential	:	MSW, LCSW
Telephone Number	:	561-573-3595

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/27/2009

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