Provider Demographics
NPI:1447775390
Name:LUFKIN, AIREL R
Entity type:Individual
Prefix:
First Name:AIREL
Middle Name:R
Last Name:LUFKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 CHICAGO WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-9313
Mailing Address - Country:US
Mailing Address - Phone:407-748-9043
Mailing Address - Fax:954-982-6491
Practice Address - Street 1:200 N VINEYARD BLVD STE 325
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3938
Practice Address - Country:US
Practice Address - Phone:860-302-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA-890103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty