Provider Demographics
NPI:1952846610
Name:TRIUMPH, STACY ALLISON (MSS, MLSP, HSV, LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ALLISON
Last Name:TRIUMPH
Suffix:
Gender:F
Credentials:MSS, MLSP, HSV, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057226001041C0700X
PACW0192661041C0700X
PA86856541041S0200X
NJ8043721041S0200X
DEQ1-00120601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW019266OtherLICENSED CLINICAL SOCIAL WORKER
NJ44SC05722600OtherLICENSED CLINICAL SOCIAL WORKER
DEQ1-0012060OtherLICENSED CLINICAL SOCIAL WORKER