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General NPI Number Information
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NPI Number | 1497545180
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Entity Type | Individual
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Provider Name | LORI GRAZIA DIBLASI PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 15 N MAIN ST STE 1
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1974
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Country | US
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Telephone | 860-519-5227
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Fax | 860-955-3036
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Provider Business Mailing Address
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Address Line | 60 EUCLID AVE
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City | STRATFORD
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State | CT
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Zip | 06614-1977
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Country | US
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Telephone | 203-212-1885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 005005
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License Number State | CT
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