Provider Demographics
NPI:1366590028
Name:ROGOW, PRISCILLA JANE (LCMHC, LADC)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:JANE
Last Name:ROGOW
Suffix:
Gender:F
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 WOODWARD NBHRD RD
Mailing Address - Street 2:
Mailing Address - City:RICHFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05476-9532
Mailing Address - Country:US
Mailing Address - Phone:802-933-7749
Mailing Address - Fax:802-933-7749
Practice Address - Street 1:111 S MAIN ST
Practice Address - Street 2:#2
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1818
Practice Address - Country:US
Practice Address - Phone:802-524-7387
Practice Address - Fax:802-933-7749
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT103525101YA0400X
VT0680000526101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007623Medicaid