Fatima Odetalla, NP in Psychiatry, PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

FATIMA ODETALLA, NP IN PSYCHIATRY, PLLC

Doing business as

Lighthouse Behavioral Health

Practice address

99 Main St Ste 302
Nyack, NY 10960-3109

Phone

(901) 590-7680

NPI assigned

Nov 13, 2020

Last updated

Nov 13, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fatima Odetalla, DNP, APRNNPI 1881005478

Title

Owner

Phone

(901) 590-7680

Specialties & licenses 2

Addresses

Other names 1

• Lighthouse Behavioral Health Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fatima Odetalla, DNP, FNP/PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Suffern, NY
  • NPI 1881005478

  Family

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1639771744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 E MALTBIE AVE",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109016007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 MAIN ST STE 302",
            "city": "NYACK",
            "state": "NY",
            "postal_code": "109603109",
            "telephone_number": "901-590-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FATIMA ODETALLA, NP IN PSYCHIATRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-13",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "ODETALLA",
        "authorized_official_first_name": "FATIMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-590-7680",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lighthouse Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Philip J Farrugia, LMHC
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• Emily Jayne Feiner, LCSW
• Junior Fernandez Fernandez Sr.
• Lisa Jane Ferrante, LCSW
• Stefanie Ferraro, CNM

• Psychiatric/Mental Health Nurse Practitioner in Nyack, NY
• Providers in Nyack, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.