Provider Demographics
NPI:1710851548
Name:FANTCHO, JEAN K
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:K
Last Name:FANTCHO
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 1:12530 FAIRWOOD PKWY STE 102-1126
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6356
Mailing Address - Country:US
Mailing Address - Phone:240-478-5592
Mailing Address - Fax:
Practice Address - Street 1:12530 FAIRWOOD PKWY STE 102-1126
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6356
Practice Address - Country:US
Practice Address - Phone:240-478-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician