Provider Demographics
NPI:1992091342
Name:DIBIASIO, LEON JOHN (MA, NCC, LCPC)
Entity type:Individual
Prefix:MR
First Name:LEON
Middle Name:JOHN
Last Name:DIBIASIO
Suffix:
Gender:M
Credentials:MA, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 BARCLAY CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2465
Mailing Address - Country:US
Mailing Address - Phone:630-200-5452
Mailing Address - Fax:
Practice Address - Street 1:6508 BARCLAY CT
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-2465
Practice Address - Country:US
Practice Address - Phone:630-200-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional