Healthcare Provider Details

I. General information

NPI: 1407767866
Provider Name (Legal Business Name): SOUL WAVE WELLNESS SERVICES LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 EUCLID AVE
BROOKLYN NY
11208-1489
US

IV. Provider business mailing address

928 FULTON STREET PMB 1001
BROOKLYN NY
11238-6909
US

V. Phone/Fax

Practice location:
  • Phone: 917-513-9571
  • Fax:
Mailing address:
  • Phone: 917-992-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHANIRA DEL CARMEN GRIFFITH
Title or Position: OWNER
Credential: LCSW
Phone: 917-992-0449