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NPI Code Detail

MEDICARE: MR. BENJAMIN DYER CDCA I

MEDICARE: MR. BENJAMIN DYER CDCA I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.167117OH

General Provider Information

NPI Number : 1760959704
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENJAMIN DYER CDCA I
Provider Business Mailing Address
First Line : 10413 HAPPYDALE RD
Second Line :
City : CAMBRIDGE
State : OH
Zip : 43725-9176
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1590 COAL RUN RD
Second Line :
City : ZANESVILLE
State : OH
Zip : 43701-9167
Country : US
Telephone Number : 740-297-4417
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2018
Last Update Date : 10/29/2018

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