Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 7050 | PA |
N | 102L00000X | Psychologist | 016799 | NY |
N | 103T00000X | Psychologist | 016799 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS016517 | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS016517 | PA |
Y | 103G00000X | Clinical Psychologist | PS016517 | PA |
Y | 103TC0700X | Clinical Psychologist | PS016517 | PA |
N | 103TF0200X | Forensic Psychologist | PS016517 | PA |
NPI | 1043437908 |
---|---|
Provider Name | Dr. Scott J Scotilla |
First Address | State College, PA 16805-0910 |
Second Address | State College, PA 16801-5923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 10/01/2022 |