Provider Demographics
NPI:1598083065
Name:MILLETTE, MARYANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:MILLETTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 N MAIN ST UNIT 88
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1463
Mailing Address - Country:US
Mailing Address - Phone:860-716-5485
Mailing Address - Fax:
Practice Address - Street 1:85 N MAIN ST UNIT 88
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1463
Practice Address - Country:US
Practice Address - Phone:860-716-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-09
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health