Provider Demographics
NPI:1184207888
Name:CORNETTE, SELENA (RBT)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:CORNETTE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 MILBURN LOOP
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-4747
Mailing Address - Country:US
Mailing Address - Phone:915-235-6878
Mailing Address - Fax:
Practice Address - Street 1:94-428 MOKUOLA ST STE 214A
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3396
Practice Address - Country:US
Practice Address - Phone:808-554-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-161104106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician