Provider Demographics
NPI:1619096955
Name:DIBIASIO, RONALD A (LCDP)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:A
Last Name:DIBIASIO
Suffix:
Gender:M
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 KENYON AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4130
Mailing Address - Country:US
Mailing Address - Phone:401-932-6773
Mailing Address - Fax:
Practice Address - Street 1:1950 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-6628
Practice Address - Country:US
Practice Address - Phone:401-294-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)