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General NPI Number Information
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NPI Number | 1659797942
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Entity Type | Individual
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Provider Name | BENJAMIN TROENDLY
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Gender | Male
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 05/21/2016
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Provider Practice Location Address
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Address Line | 1225 WOODLAWN AVE SUITE 112
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City | CAMBRIDGE
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State | OH
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Zip | 43725-3094
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Country | US
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Telephone | 855-692-7247
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Fax | 855-692-7247
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Provider Business Mailing Address
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Address Line | 835 KENILWORTH AVE
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City | COSHOCTON
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State | OH
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Zip | 43812-2367
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Country | US
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Telephone | 855-692-7247
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Fax | 855-692-7247
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ICDC.121149-CS
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1500230
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License Number State | OH
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