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Contact Information

MARIO DI BIASE, PSY.D.
7149 BLACKSHEEP RUN
FORT CAMPBELL, KY42223
 Phone: 270-798-8727
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for MARIO DI BIASE · (Male)

NPI # 1366592693
Status Active
Credentials PSY.D. (Doctor of Psychology)
Entity Individual
Enumeration date 01/11/2007
Last updated 10/03/2024 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • IL License # 071006045
  • TN License # 3803
  • TX License # 37800
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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