Provider Demographics
NPI:1558198036
Name:ROOF, BENJAMIN TAYLOR
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TAYLOR
Last Name:ROOF
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 1:8567 S MASON MONTGOMERY RD STE 34
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9805
Mailing Address - Country:US
Mailing Address - Phone:513-202-3096
Mailing Address - Fax:
Practice Address - Street 1:8567 S MASON MONTGOMERY RD STE 34
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9805
Practice Address - Country:US
Practice Address - Phone:513-202-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291293101YM0800X
OHE.2404707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health