National Provider Identifier
Demetric Pentelton
Demetric Pentelton is listed in the NPPES registry with a primary specialty of Mental Health Counselor in Buffalo, NY and a listed phone number of (716) 884-0700.
Profile Overview
- NPI
- 1669833836
- Provider Type
- Individual
- Primary Specialty
- Mental Health Counselor
- Enumeration Date
- March 15, 2016
- Last Updated
- September 18, 2024
Practice Location
- 951 Niagara St
- Buffalo, NY 14213-2116
Phone: (716) 884-0700
Mailing Address
- 59 Zenner St
- Buffalo, NY 14211-1707
Specialties
- Mental Health Counselor (101YM0800X)
- Counselor (101Y00000X)
Full Record
- NPI
- 1669833836
- Entity Type
- Individual
- Last Name
- Pentelton
- First Name
- Demetric
- Mailing Street Address
- 59 Zenner St
- Mailing City
- Buffalo
- Mailing State
- NY
- Mailing ZIP Code
- 14211-1707
- Mailing Country
- US
- Mailing Phone
- (716) 578-2563
- Practice Street Address
- 951 Niagara St
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14213-2116
- Practice Country
- US
- Practice Phone
- (716) 884-0700
- Enumeration Date
- March 15, 2016
- Last Updated
- September 18, 2024
- Deactivation Date
- November 19, 2019
- Reactivation Date
- March 09, 2020
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- September 18, 2024
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Mental Health Counselor (101YM0800X), Counselor (101Y00000X)