Demetric Pentelton

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

009824 Issued in NY

Practice address

951 Niagara St
Buffalo, NY 14213-2116

Phone

(716) 884-0700

NPI assigned

Mar 15, 2016

Reactivated

Mar 9, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: demetricpentelton@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Colorwell Therapy LLC

  • Mental Health Counselor
  • Rochester, NY
  • NPI 1689382640
  NPD Authorized official
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Counselor

  NPD

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

{
    "created_epoch": "1458000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1669833836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 ZENNER ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142111707",
            "telephone_number": "716-578-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 NIAGARA ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142132116",
            "telephone_number": "716-884-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENTELTON",
        "first_name": "DEMETRIC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-15",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "deactivation_date": "2019-11-19",
        "reactivation_date": "2020-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NY",
            "license": "009824",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "009824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Mortimer Pennington, NP
• Marina Pennock
• Daniel Penque
• Michelle Dolores Penque, MD
• Ali Nicole Pensero, CRNA
• People First Mobility, LLC
• People Home Health Care Services Certified, Inc.
• People Inc
• People Inc.
• People Inc.

• Mental Health Counselor in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.