Provider Demographics
NPI:1164035929
Name:DIBLASI, HEAHER DAWN
Entity Type:Individual
Prefix:
First Name:HEAHER
Middle Name:DAWN
Last Name:DIBLASI
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 1:24 NAUTILUS DR
Mailing Address - Street 2:
Mailing Address - City:LEONARDO
Mailing Address - State:NJ
Mailing Address - Zip Code:07737-1307
Mailing Address - Country:US
Mailing Address - Phone:908-601-5091
Mailing Address - Fax:
Practice Address - Street 1:2040 6TH AVE STE C&D
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6101
Practice Address - Country:US
Practice Address - Phone:908-601-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00312100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)