Healthcare Provider Details

I. General information

NPI: 1487323747
Provider Name (Legal Business Name): GINA AMANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FAIR ST FL 1
WALLINGFORD CT
06492-4208
US

IV. Provider business mailing address

45 FAIR ST FL 1
WALLINGFORD CT
06492-4208
US

V. Phone/Fax

Practice location:
  • Phone: 203-414-1059
  • Fax:
Mailing address:
  • Phone: 203-951-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number011710
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: