Healthcare Provider Details

I. General information

NPI: 1679481717
Provider Name (Legal Business Name): GINA ANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BEACON ST STE 7
BROOKLINE MA
02446-5587
US

IV. Provider business mailing address

8 VINAL ST APT 7
BRIGHTON MA
02135-7667
US

V. Phone/Fax

Practice location:
  • Phone: 617-398-4503
  • Fax:
Mailing address:
  • Phone: 832-226-8724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: