Provider Demographics
NPI:1043383979
Name:DEMETRI, JAMES PETER (LCSW, DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PETER
Last Name:DEMETRI
Suffix:
Gender:M
Credentials:LCSW, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NATHAN PIERCE CT
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-2161
Mailing Address - Country:US
Mailing Address - Phone:845-855-0799
Mailing Address - Fax:
Practice Address - Street 1:503 E 78TH ST APT 1H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1130
Practice Address - Country:US
Practice Address - Phone:845-702-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33559122300000X
NY082201-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No122300000XDental ProvidersDentist