Provider Demographics
NPI:1376762641
Name:HONICKMAN, GARY (PHD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:HONICKMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 E SILVER SPRINGS BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6758
Mailing Address - Country:US
Mailing Address - Phone:352-732-0506
Mailing Address - Fax:352-732-7592
Practice Address - Street 1:1107 E SILVER SPRINGS BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6758
Practice Address - Country:US
Practice Address - Phone:352-732-0506
Practice Address - Fax:352-732-7592
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical