Provider Demographics
NPI:1043437908
Name:SCOTILLA, SCOTT J (PSYD ICAADC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:SCOTILLA
Suffix:
Gender:M
Credentials:PSYD ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10910
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16805-0910
Mailing Address - Country:US
Mailing Address - Phone:814-867-2866
Mailing Address - Fax:866-283-4558
Practice Address - Street 1:1315 S ALLEN ST STE 303
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5923
Practice Address - Country:US
Practice Address - Phone:814-867-2866
Practice Address - Fax:866-283-4558
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016517103TC0700X, 103TA0400X, 103TB0200X, 103TF0200X
PA7050101YA0400X
NY016799103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic