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General NPI Number Information
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NPI Number | 1851305759
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Entity Type | Organization
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Legal Business Name | COLLEGEVILLE PSYCHOLOGICAL CENTER INC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 3774 RIDGE PIKE
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-3169
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Country | US
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Telephone | 610-489-3330
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Fax | 610-489-9390
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | GWYNEDD VALLEY
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State | PA
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Zip | 19437
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Country | US
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Telephone | 610-489-3330
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Fax | 610-489-9390
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Authorized Official
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Title or Position | PRESIDENT MEDICAL DIRECTOR
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Name | SAMIR F FARAQ
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Credential | MD
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Telephone | 610-489-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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