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General NPI Number Information
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NPI Number | 1518779933
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Entity Type | Individual
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Provider Name | RAPHNA ETIENNE
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Gender | Female
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 4917 GOLDEN TRIANGLE BLVD STE 421
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City | FORT WORTH
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State | TX
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Zip | 76244-4673
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Country | US
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Telephone | 817-754-4938
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Fax | 817-717-8584
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Provider Business Mailing Address
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Address Line | 5429 CARIBOU RIDGE DR
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City | WATAUGA
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State | TX
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Zip | 76137-4722
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Country | US
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Telephone | 817-368-3847
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-386909
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License Number State | TX
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