Healthcare Provider Details

I. General information

NPI: 1164390357
Provider Name (Legal Business Name): KAREN GRYGIEL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HOPE RD SUITES 5B,5A,4A
EATONTOWN NJ
07724
US

IV. Provider business mailing address

2200 NJ-66 SUITE 3-PMB 111
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 732-858-5432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00890100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: