Healthcare Provider Details

I. General information

NPI: 1710709639
Provider Name (Legal Business Name): PIONEER BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 DWIGHT RD
LONGMEADOW MA
01106-1576
US

IV. Provider business mailing address

175 DWIGHT RD
LONGMEADOW MA
01106-1576
US

V. Phone/Fax

Practice location:
  • Phone: 781-382-8201
  • Fax:
Mailing address:
  • Phone: 781-382-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JARED STANLEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 781-382-8201