Provider Demographics
NPI:1104683549
Name:PIONEER VALLEY MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:PIONEER VALLEY MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:COOKISH
Authorized Official - Suffix:III
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-388-9074
Mailing Address - Street 1:68 HARRISON AVE
Mailing Address - Street 2:STE 605 NUM486928
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1929
Mailing Address - Country:US
Mailing Address - Phone:413-388-9074
Mailing Address - Fax:
Practice Address - Street 1:120 GREEN MANOR RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4115
Practice Address - Country:US
Practice Address - Phone:413-388-9074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health