Provider Demographics
NPI:1467405258
Name:KURKJIAN, JOHN MITCHELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MITCHELL
Last Name:KURKJIAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001989103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical