Healthcare Provider Details

I. General information

NPI: 1851305759
Provider Name (Legal Business Name): COLLEGEVILLE PSYCHOLOGICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 RIDGE PIKE
EAGLEVILLE PA
19403-1411
US

IV. Provider business mailing address

PO BOX 187
GWYNEDD VALLEY PA
19437-0187
US

V. Phone/Fax

Practice location:
  • Phone: 610-917-2200
  • Fax: 610-917-2360
Mailing address:
  • Phone: 610-917-2200
  • Fax: 610-917-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMIR F FARAQ
Title or Position: PRESIDENT MEDICAL DIRECTOR
Credential: MD
Phone: 610-917-2200