MEDICARE: ALAN ICKOWITZ, PSY.D., P.A.

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PY5649	FL
2	103T00000X	Psychologist	PY5649	FL
3	103TC0700X	Clinical Psychologist	PY5649	FL

General Provider Information

NPI Number	:	1861510091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN ICKOWITZ, PSY.D., P.A.

Provider Business Mailing Address
First Line	:	6105 MEMORIAL HWY
Second Line	:	STE B
City	:	TAMPA
State	:	FL
Zip	:	33615-4597
Country	:	US
Telephone Number	:	813-814-9839
Fax Number	:	813-200-1044

Provider Business Practice Location Address
First Line	:	6105 MEMORIAL HWY
Second Line	:	STE B
City	:	TAMPA
State	:	FL
Zip	:	33615-4597
Country	:	US
Telephone Number	:	813-814-9839
Fax Number	:	813-200-1044

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALAN Y ICKOWITZ
Credential	:	PSY.D.
Telephone Number	:	813-814-9839

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	09/11/2025

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