Provider Demographics
NPI:1336241967
Name:SOTTILE, RUSSELL J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:J
Last Name:SOTTILE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WHALEPOND RD
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1246
Mailing Address - Country:US
Mailing Address - Phone:732-263-1715
Mailing Address - Fax:
Practice Address - Street 1:1011 BOND ST
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-5939
Practice Address - Country:US
Practice Address - Phone:732-869-2766
Practice Address - Fax:732-897-9541
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05186100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health