Provider Demographics
NPI:1659797942
Name:TROENDLY, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:TROENDLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2367
Mailing Address - Country:US
Mailing Address - Phone:855-692-7247
Mailing Address - Fax:855-692-7247
Practice Address - Street 1:1225 WOODLAWN AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3094
Practice Address - Country:US
Practice Address - Phone:855-692-7247
Practice Address - Fax:855-692-7247
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC.121149-CS101YA0400X
OHI.15002301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)