Provider Demographics
NPI:1801438981
Name:MARKETTE, JOHN-TYLER (COUNSELING)
Entity type:Individual
Prefix:
First Name:JOHN-TYLER
Middle Name:
Last Name:MARKETTE
Suffix:
Gender:M
Credentials:COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVENUE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:203-503-3183
Practice Address - Street 1:62 GRANT STREET
Practice Address - Street 2:GRANT STREET PARTNERSHIP
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-3456
Practice Address - Country:US
Practice Address - Phone:203-503-3350
Practice Address - Fax:203-503-3370
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional