Alan Y Ickowitz, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY5649 Issued in FL

Practice address

201 Douglas Ave Ste a
Dunedin, FL 34698-7953

Phone

(813) 814-9839

Fax

(813) 200-1044

NPI assigned

Mar 26, 2007

Last updated

Oct 16, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2014 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alan Ickowitz, Psy.D., P.a.

  • Clinical Psychologist
  • Tampa, FL
  • NPI 1861510091
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602806400000",
    "number": "1083732200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 DOUGLAS AVE STE A",
            "city": "DUNEDIN",
            "state": "FL",
            "postal_code": "346987953",
            "telephone_number": "813-814-9839",
            "fax_number": "813-200-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 DOUGLAS AVE STE A",
            "city": "DUNEDIN",
            "state": "FL",
            "postal_code": "346987953",
            "telephone_number": "813-814-9839",
            "fax_number": "813-200-1044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICKOWITZ",
        "first_name": "ALAN",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5649",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "PY5649",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY5649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Hyppolite Jr.
• Natalie Rose Iafe, MA
• Carolyn Maria Ibrahim Pavlich, RDN
• Ester Ibrahim
• Daven Icao, COTA
• Rachel Ikensaa, DPT
• Infectious Disease Physicians
• Inspired Senior Living of Dunedin Mt, LLC (Salterra Senior Living at Dunedin)
• Invicta Park Place LLC (Park Place Assisted Living)
• Invision Eyecare Inc.

• Clinical Psychologist in Dunedin, FL
• Providers in Dunedin, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.