Healthcare Provider Details

I. General information

NPI: 1497545180
Provider Name (Legal Business Name): LORI GRAZIA DIBLASI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N MAIN ST STE 1
WEST HARTFORD CT
06107-1974
US

IV. Provider business mailing address

60 EUCLID AVE
STRATFORD CT
06614-1977
US

V. Phone/Fax

Practice location:
  • Phone: 860-519-5227
  • Fax: 860-955-3036
Mailing address:
  • Phone: 203-212-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005005
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: