Provider Demographics
NPI:1225213184
Name:ZWILLING, LARA LYN
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:LYN
Last Name:ZWILLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9939 NW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8008
Mailing Address - Country:US
Mailing Address - Phone:352-222-5945
Mailing Address - Fax:352-335-1902
Practice Address - Street 1:6210 NW 43RD ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653
Practice Address - Country:US
Practice Address - Phone:352-222-5945
Practice Address - Fax:352-335-1902
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health