Provider Demographics
NPI:1477244267
Name:TRIUMPH THERAPEUTIC & CONSULTING GROUP
Entity Type:Organization
Organization Name:TRIUMPH THERAPEUTIC & CONSULTING GROUP
Other - Org Name:STACY TRIUMPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:TRIUMPH
Authorized Official - Suffix:
Authorized Official - Credentials:CST, CSWT, LCSW
Authorized Official - Phone:267-931-8824
Mailing Address - Street 1:45 E CITY AVE # 1954
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2421
Mailing Address - Country:US
Mailing Address - Phone:267-931-8824
Mailing Address - Fax:
Practice Address - Street 1:19 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022
Practice Address - Country:US
Practice Address - Phone:267-931-8824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904016003OtherLICENSED CLINICAL SOCIAL WORKER
DEQ1-0012060OtherLICENSED CLINICAL SOCIAL WORKER
MD14785OtherLICENSED CLINICAL SOCIAL WORKER
PACW019266OtherLICENSED CLINICAL SOCIAL WORKER
NJ44SC05722600OtherLICENSED CLINICAL SOCIAL WORKER
DCLC200002949OtherLICENSED CLINICAL SOCIAL WORKER