Provider Demographics
NPI:1285813675
Name:DIBLASIO, FREDERICK ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ANDREW
Last Name:DIBLASIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GRAYS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-5510
Mailing Address - Country:US
Mailing Address - Phone:410-706-7799
Mailing Address - Fax:
Practice Address - Street 1:429 ASBURY DR
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1373
Practice Address - Country:US
Practice Address - Phone:410-706-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD053211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ933Medicare PIN