Provider Demographics
NPI:1851830780
Name:IMONDI, COURTNEY (LMHC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:IMONDI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BRIARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-1447
Mailing Address - Country:US
Mailing Address - Phone:401-330-7348
Mailing Address - Fax:401-226-0899
Practice Address - Street 1:1200 HARTFORD AVE UNIT 124
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7144
Practice Address - Country:US
Practice Address - Phone:401-330-7348
Practice Address - Fax:401-226-0899
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12638101Y00000X, 101YM0800X
RIMHC01062101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health