Provider Demographics
NPI:1053094771
Name:GAGE ENTERPRISES ABA THERAPY LLC
Entity type:Organization
Organization Name:GAGE ENTERPRISES ABA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERENA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:407-840-4751
Mailing Address - Street 1:2428 MARZEL AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5703
Mailing Address - Country:US
Mailing Address - Phone:407-840-4751
Mailing Address - Fax:
Practice Address - Street 1:2428 MARZEL AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5703
Practice Address - Country:US
Practice Address - Phone:407-840-4751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty