| NPI | 1861510091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN Y ICKOWITZ President 813-814-9839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY5649) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY5649) |
| 103T00000X Psychologist (Licence: FL PY5649) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |