Provider Demographics
NPI:1629642632
Name:GAMEBRED YOUTH & FAMILIES
Entity Type:Organization
Organization Name:GAMEBRED YOUTH & FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:SNYDER
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-846-9807
Mailing Address - Street 1:8321 NW 7TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3916
Mailing Address - Country:US
Mailing Address - Phone:305-647-8065
Mailing Address - Fax:
Practice Address - Street 1:450 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2636
Practice Address - Country:US
Practice Address - Phone:305-647-8065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health