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General NPI Number Information
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NPI Number | 1922729375
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Entity Type | Organization
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Legal Business Name | STEAM 4 URBN YOUTH, INC.
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 800 BROAD ST # 323
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City | NEWARK
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State | NJ
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Zip | 07102-2760
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Country | US
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Telephone | 678-651-9778
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Fax |
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Provider Business Mailing Address
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Address Line | 8 LOMBARDY ST # 176
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City | NEWARK
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State | NJ
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Zip | 07102-3210
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Country | US
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Telephone | 678-651-9778
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | FALLON DAVIS
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Credential | M.ED
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Telephone | 678-651-9778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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