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Organization
FATIMA ODETALLA, NP IN PSYCHIATRY, PLLC
Active
Organization
FATIMA ODETALLA, NP IN PSYCHIATRY, PLLC
Active
Other names
Lighthouse Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FATIMA ODETALLA DNP, APRN (OWNER)
(901) 590-7680
Entity
Organization
Contact information
Practice address
99 MAIN ST STE 302, NYACK, NY 10960-3109
(901) 590-7680
Mailing address
65 E MALTBIE AVE, SUFFERN, NY 10901-6007
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/13/2020
Last updated
11/13/2020
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