Provider Demographics
NPI:1790209872
Name:DI BIASE, BENJAMIN MICHEL
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHEL
Last Name:DI BIASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 JOHN TYE RD
Mailing Address - Street 2:
Mailing Address - City:ROSALIA
Mailing Address - State:WA
Mailing Address - Zip Code:99170-9630
Mailing Address - Country:US
Mailing Address - Phone:509-768-3682
Mailing Address - Fax:
Practice Address - Street 1:402 JOHN TYE RD
Practice Address - Street 2:
Practice Address - City:ROSALIA
Practice Address - State:WA
Practice Address - Zip Code:99170-9630
Practice Address - Country:US
Practice Address - Phone:509-768-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW611021811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical