John Ickowski

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PC015817 Issued in PA

Practice address

3222 Sussex Way
Vero Beach, FL 32966-6473

Phone

(717) 622-1111

NPI assigned

Sep 5, 2023

Last updated

Sep 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• M3 Haven Inc.

  dba Ellie Mental Health - Space Coast

  • Clinical Social Worker
  • Melbourne, FL
  • NPI 1831945484

  Mental Health

  Medicare reassignment NPD

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

{
    "created_epoch": "1693872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1659157717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3222 SUSSEX WAY",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329666473",
            "telephone_number": "717-622-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3222 SUSSEX WAY",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329666473",
            "telephone_number": "717-622-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICKOWSKI",
        "first_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-05",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "PC015817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thy Huynh
• I. Basil Keller, M.D.
• I. Basil Keller, M.D.
• Daniela Andreina Ibarra, ARNP PMHNP-BC FNP-C
• Ibelieve Maternal Wellness & Counseling Center, Inc
• Adriana Iglesias
• Lubka B. Ilieva, D.O.
• Latia Holder Ilyadis, D.O.
• Imagine Schools at South Vero
• Indian River Assisting Services PA

• Mental Health Counselor in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.