Marc Dylan Gagnon, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

12627 Issued in CT

Practice address

21 Waterville Rd
Avon, CT 06001-2097

Phone

(860) 284-0182

NPI assigned

Nov 20, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Harvest Healthcare LLCGroup PAC ID 9931276979, 72 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Harvest Healthcare LLC

  • Clinical Social Worker
  • Avon, CT
  • NPI 1477712917
  Medicare reassignment Care Compare group NPD
• The Center for Geriatric and Family Psychiatry, Inc.

  • Mental Health Counselor
  • Glastonbury, CT
  • NPI 1831134766
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1508631623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 LOCUST RD",
            "city": "HARWINTON",
            "state": "CT",
            "postal_code": "067912412",
            "telephone_number": "203-233-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 WATERVILLE RD",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060012097",
            "telephone_number": "860-284-0182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "MARC",
        "middle_name": "DYLAN",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-20",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "12627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenn Martin Fryer
• Sara Furtak, LCSW
• Jacqueline Fusari, LAC
• Maria G Gaer, APRN-BC
• Debra Anne Gage, APRN
• Wiktoria Anna Galica, PA-C
• Alissa Gandiaga
• Michael Gans, PT
• David W Garry, PA-C
• Sharon M Gauthier, RN

• Psychiatric/Mental Health Nurse Practitioner in Avon, CT
• Providers in Avon, CT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.