Provider Demographics
NPI:1841651999
Name:LUEBKEMAN, BLAIRE (MS - BCBA)
Entity type:Individual
Prefix:
First Name:BLAIRE
Middle Name:
Last Name:LUEBKEMAN
Suffix:
Gender:F
Credentials:MS - BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 WOODBURY AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2808
Mailing Address - Country:US
Mailing Address - Phone:603-433-4192
Mailing Address - Fax:
Practice Address - Street 1:2064 WOODBURY AVE STE 204
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-2808
Practice Address - Country:US
Practice Address - Phone:603-433-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-13120103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst