Healthcare Provider Details

I. General information

NPI: 1356409783
Provider Name (Legal Business Name): MARK MANLEY ZWINGELBERG PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 LAKE ALFRED ROAD WINTER HAVEN HOSPITAL REHABILITATION SERVICES
WINTER HAVEN FL
33881
US

IV. Provider business mailing address

4503 BRANDYWOOD PLACE
LAKELAND FL
33801
US

V. Phone/Fax

Practice location:
  • Phone: 863-292-4061
  • Fax: 863-293-6985
Mailing address:
  • Phone: 863-666-3838
  • Fax: 863-666-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 3630
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 3630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: