Provider Demographics
NPI:1194904615
Name:JOHN KURKJIAN, LLC
Entity type:Organization
Organization Name:JOHN KURKJIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:KURKJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-529-8432
Mailing Address - Street 1:750 OLD MAIN ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1567
Mailing Address - Country:US
Mailing Address - Phone:860-529-8432
Mailing Address - Fax:860-529-3461
Practice Address - Street 1:750 OLD MAIN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1567
Practice Address - Country:US
Practice Address - Phone:860-529-8432
Practice Address - Fax:860-529-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001989103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03365Medicare PIN