Healthcare Provider Details

I. General information

NPI: 1184482499
Provider Name (Legal Business Name): GOLDEN YEARS BEHAVIORAL HEALTH GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SHAKER RD
EAST LONGMEADOW MA
01028
US

IV. Provider business mailing address

18 SHAKER RD
EAST LONGMEADOW MA
01028
US

V. Phone/Fax

Practice location:
  • Phone: 413-216-2214
  • Fax: 413-318-4999
Mailing address:
  • Phone: 413-216-2214
  • Fax: 413-318-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SARA MARIE KENDALL
Title or Position: VP OF CLINICAL OPERATIONS
Credential:
Phone: 413-519-0497