Provider Demographics
NPI:1376323485
Name:INMON, BRAEDYN D'MITRI (LPC-A)
Entity Type:Individual
Prefix:
First Name:BRAEDYN
Middle Name:D'MITRI
Last Name:INMON
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RAE
Other - Last Name:INMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:887 MAIN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2800
Mailing Address - Country:US
Mailing Address - Phone:203-990-1215
Mailing Address - Fax:
Practice Address - Street 1:102 HOWARD AVE APT 1
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2265
Practice Address - Country:US
Practice Address - Phone:214-995-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6637101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional