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General NPI Number Information
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NPI Number | 1386363240
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Entity Type | Organization
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Legal Business Name | BRAIN WAVES PLLC
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 15 GLIDDEN RD STE 6
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City | MOULTONBOROUGH
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State | NH
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Zip | 03254-3698
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Country | US
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Telephone | 603-441-5851
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Fax |
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Provider Business Mailing Address
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Address Line | 15 GLIDDEN RD STE 6
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City | MOULTONBOROUGH
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State | NH
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Zip | 03254-3698
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Country | US
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Telephone | 603-441-5851
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MRS. MADELINE SHIEL
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Credential | LCMHC
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Telephone | 724-987-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | NULL
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