Provider Demographics
NPI:1639310584
Name:BOUJIKIAN, MARK (LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BOUJIKIAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1328
Mailing Address - Country:US
Mailing Address - Phone:845-486-2750
Mailing Address - Fax:845-485-2759
Practice Address - Street 1:9 MANSION ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2309
Practice Address - Country:US
Practice Address - Phone:845-486-3721
Practice Address - Fax:845-486-3727
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health