Provider Demographics
NPI:1447048731
Name:MARKETTE, NICO DYLAN-GRANT
Entity type:Individual
Prefix:
First Name:NICO
Middle Name:DYLAN-GRANT
Last Name:MARKETTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BOULDER PASS APT 130
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-4951
Mailing Address - Country:US
Mailing Address - Phone:203-695-9518
Mailing Address - Fax:
Practice Address - Street 1:500 BOULDER PASS APT 130
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-4951
Practice Address - Country:US
Practice Address - Phone:203-695-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health