Healthcare Provider Details

I. General information

NPI: 1871410571
Provider Name (Legal Business Name): BOTROS BARSOUM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 FAIRVIEW RD STE 201
SWARTHMORE PA
19081-2335
US

IV. Provider business mailing address

333 PROSPECT AVE
BRIDGEPORT PA
19405-1619
US

V. Phone/Fax

Practice location:
  • Phone: 610-765-1109
  • Fax:
Mailing address:
  • Phone: 610-504-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC019912
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: