Provider Demographics
NPI:1386363240
Name:BRAIN WAVES PLLC
Entity type:Organization
Organization Name:BRAIN WAVES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:724-987-0040
Mailing Address - Street 1:15 GLIDDEN RD STE 6
Mailing Address - Street 2:
Mailing Address - City:MOULTONBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03254-3698
Mailing Address - Country:US
Mailing Address - Phone:603-441-5851
Mailing Address - Fax:
Practice Address - Street 1:15 GLIDDEN RD STE 6
Practice Address - Street 2:
Practice Address - City:MOULTONBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03254-3698
Practice Address - Country:US
Practice Address - Phone:603-441-5851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)