Provider Demographics
NPI:1568358364
Name:GRAYSON, GARETH (LAMFT)
Entity type:Individual
Prefix:
First Name:GARETH
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6024
Mailing Address - Country:US
Mailing Address - Phone:732-867-1412
Mailing Address - Fax:
Practice Address - Street 1:4 CORNWALL DR STE 103
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3332
Practice Address - Country:US
Practice Address - Phone:908-669-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00054200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist