Provider Demographics
NPI:1760879191
Name:MYLOTT, ROSE M (LADC, LCMHC)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:MYLOTT
Suffix:
Gender:F
Credentials:LADC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CHARTER HILL DR
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3750
Mailing Address - Country:US
Mailing Address - Phone:802-768-1279
Mailing Address - Fax:
Practice Address - Street 1:14 CHARTER HILL DR
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3750
Practice Address - Country:US
Practice Address - Phone:802-768-1279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0120531101YM0800X
VT000618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0000303Medicaid