=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184592057
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY LUGLI MA, LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2025
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 HOPE RD STE 5B
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724-1273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-858-5432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 BEDLE RD
-----------------------------------------------------
City | HAZLET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07730-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-500-6570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37AC00917900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------