Provider Demographics
NPI:1538781836
Name:SOTTILE, REAGAN JULIANA
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:JULIANA
Last Name:SOTTILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-8704
Mailing Address - Country:US
Mailing Address - Phone:914-388-7813
Mailing Address - Fax:
Practice Address - Street 1:11 WARREN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-3117
Practice Address - Country:US
Practice Address - Phone:518-641-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106650-01041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical