Provider Demographics
NPI:1467151142
Name:FANNEY, CHANTAL M
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:M
Last Name:FANNEY
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 1:6399 FENHAM ST APT 16
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3731
Mailing Address - Country:US
Mailing Address - Phone:510-213-3339
Mailing Address - Fax:
Practice Address - Street 1:6399 FENHAM ST APT 16
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-3731
Practice Address - Country:US
Practice Address - Phone:510-213-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst