MEDICARE: GARY HONICKMAN PHD

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	103TC0700X	Clinical Psychologist	PY2874	FL

General Provider Information

NPI Number	:	1376762641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY HONICKMAN PHD

Provider Business Mailing Address
First Line	:	1107 E SILVER SPRINGS BLVD
Second Line	:	SUITE 9
City	:	OCALA
State	:	FL
Zip	:	34470-6758
Country	:	US
Telephone Number	:	352-732-0506
Fax Number	:	352-732-7592

Provider Business Practice Location Address
First Line	:	1107 E SILVER SPRINGS BLVD
Second Line	:	SUITE 9
City	:	OCALA
State	:	FL
Zip	:	34470-6758
Country	:	US
Telephone Number	:	352-732-0506
Fax Number	:	352-732-7592

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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