Provider Demographics
NPI:1770201576
Name:SQUILLANTE, ANNAROSE (LMHC)
Entity type:Individual
Prefix:
First Name:ANNAROSE
Middle Name:
Last Name:SQUILLANTE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:THETFORD CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05075-9057
Mailing Address - Country:US
Mailing Address - Phone:401-742-7273
Mailing Address - Fax:
Practice Address - Street 1:4640 ROUTE 5
Practice Address - Street 2:
Practice Address - City:THETFORD CENTER
Practice Address - State:VT
Practice Address - Zip Code:05075-9057
Practice Address - Country:US
Practice Address - Phone:401-742-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty