Provider Demographics
NPI:1447309109
Name:MOKKOSIAN, JOHN (D MIN)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MOKKOSIAN
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LUCILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2055
Mailing Address - Country:US
Mailing Address - Phone:603-893-5181
Mailing Address - Fax:
Practice Address - Street 1:130 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3176
Practice Address - Country:US
Practice Address - Phone:603-890-6767
Practice Address - Fax:603-893-6767
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH54101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009668Medicaid