MEDICARE: MS. CAROL L CAPTAIN CAROL CAPTAIN, LMFT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	2680	FL
2	106H00000X	Marriage & Family Therapist	MT1975	FL

General Provider Information

NPI Number	:	1497961981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL L CAPTAIN CAROL CAPTAIN, LMFT

Provider Business Mailing Address
First Line	:	8081 PALMETTO PALM CIR
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-2729
Country	:	US
Telephone Number	:	954-465-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	7481 W OAKLAND PARK BLVD STE 308
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-4961
Country	:	US
Telephone Number	:	954-465-5544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	12/18/2007

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