Provider Demographics
NPI:1407339344
Name:DIBIASE, DHIRA (PSYD)
Entity type:Individual
Prefix:DR
First Name:DHIRA
Middle Name:
Last Name:DIBIASE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 ALIHI PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3981
Mailing Address - Country:US
Mailing Address - Phone:808-386-6326
Mailing Address - Fax:
Practice Address - Street 1:591 ALIHI PL
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3981
Practice Address - Country:US
Practice Address - Phone:808-636-3674
Practice Address - Fax:808-373-2810
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1730103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical