Provider Demographics
NPI:1497545180
Name:DIBLASI, LORI GRAZIA (PSYD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:GRAZIA
Last Name:DIBLASI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1977
Mailing Address - Country:US
Mailing Address - Phone:203-212-1885
Mailing Address - Fax:
Practice Address - Street 1:15 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1974
Practice Address - Country:US
Practice Address - Phone:860-519-5227
Practice Address - Fax:860-955-3036
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical