Organization
COLLEGEVILLE PSYCHOLOGICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMIR F FARAQ MD (PRESIDENT MEDICAL DIRECTOR)
(610) 917-2200
Entity
Organization
Contact information
Practice address
3301 RIDGE PIKE, EAGLEVILLE, PA 19403-1411
(610) 917-2200
(610) 917-2360
Mailing address
PO BOX 187, GWYNEDD VALLEY, PA 19437-0187
(610) 917-2200
(610) 917-2360
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012250080001
—
PA
Enumeration date
07/28/2006
Last updated
03/20/2026
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