Provider Demographics
NPI:1154895704
Name:DIBIASE, TRISHA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:DIBIASE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ALBANY TPKE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2540
Mailing Address - Country:US
Mailing Address - Phone:860-385-3751
Mailing Address - Fax:860-371-3105
Practice Address - Street 1:320 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2540
Practice Address - Country:US
Practice Address - Phone:860-385-3751
Practice Address - Fax:860-371-3105
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8046363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health