| Entity Name: | ALAN ICKOWITZ, PSY.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 11 Dec 2003 (21 years ago) |
| Document Number: | P03000149285 |
| FEI/EIN Number | 562422664 |
| Address: | 201 Douglas Ave, Dunedin, FL, 34698, US |
| Mail Address: | 201 Douglas Ave, Dunedin, FL, 34698, US |
| ZIP code: | 34698 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861510091 | 2007-03-26 | 2020-08-22 | 6105 MEMORIAL HWY, STE B, TAMPA, FL, 336154597, US | 6105 MEMORIAL HWY, STE B, TAMPA, FL, 336154597, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 813-814-9839 |
| Fax | 8132001044 |
Authorized person
| Name | DR. ALAN Y ICKOWITZ |
| Role | PRESIDENT |
| Phone | 8138149839 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| License Number | PY5649 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 103TA0400X - Addiction (Substance Use Disorder) Psychologist |
| License Number | PY5649 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY5649 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| ICKOWITZ ALAN | Agent | 201 Douglas Ave, Dunedin, FL, 34698 |
| Name | Role | Address |
|---|---|---|
| ICKOWITZ ALAN | Director | 201 Douglas Ave, Dunedin, FL, 34698 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-29 | 201 Douglas Ave, Suite A, Dunedin, FL 34698 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-29 | 201 Douglas Ave, Suite A, Dunedin, FL 34698 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-29 | 201 Douglas Ave, Suite A, Dunedin, FL 34698 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-03-03 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-02-06 |
| ANNUAL REPORT | 2019-02-28 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-04-04 |
| ANNUAL REPORT | 2015-04-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
