Provider Demographics
NPI:1073257119
Name:HARBERT, DAPHANEE S
Entity Type:Individual
Prefix:
First Name:DAPHANEE
Middle Name:S
Last Name:HARBERT
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 1:14285 FAA BLVD APT 4213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-2660
Mailing Address - Country:US
Mailing Address - Phone:817-703-1557
Mailing Address - Fax:
Practice Address - Street 1:14285 FAA BLVD APT 4213
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76155-2660
Practice Address - Country:US
Practice Address - Phone:817-703-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities