Provider Demographics
NPI:1689621922
Name:DIBLASIO, CHRISTINE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:DIBLASIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 RYE CIRCLE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-654-7607
Mailing Address - Fax:802-654-9155
Practice Address - Street 1:27 RYE CIRCLE
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6209
Practice Address - Country:US
Practice Address - Phone:802-654-7607
Practice Address - Fax:802-654-9155
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT48-0000456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002861Medicaid
VTDIVN2493Medicare Oscar/Certification
VTDIVN2493Medicare UPIN
VT1002861Medicaid