Healthcare Provider Details

I. General information

NPI: 1205137023
Provider Name (Legal Business Name): ODETTE SPENCER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PROSPECT STREET
NORWALK CT
06850-3750
US

IV. Provider business mailing address

23 PROSPECT STREET
NORWALK CT
06850-3705
US

V. Phone/Fax

Practice location:
  • Phone: 718-877-3763
  • Fax:
Mailing address:
  • Phone: 718-877-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10862
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335890-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403966-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: