| Organization Name: | JOHN KURKJIAN, LLC |
| NPI Number: | 1194904615 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN MITCHELL KURKJIAN (PRESIDENT) |
| Mailing Address: | 750 Old Main St Suite 306 Rocky Hill |
| State: | CT US |
| Postal Code: | 060671567 |
| Phone Number: | 8605298432 |
| Fax Number: | 8605293461 |
| NPI Enumeration Date: | 11/01/2007 |
| NPI Last Update Date: | 11/01/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 001989 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |