Healthcare Provider Details

I. General information

NPI: 1770413098
Provider Name (Legal Business Name): TARCILA LOPES BURKHARDT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5013 ORCHARD DR
ELLICOTT CITY MD
21043-6726
US

IV. Provider business mailing address

5013 ORCHARD DR
ELLICOTT CITY MD
21043-6726
US

V. Phone/Fax

Practice location:
  • Phone: 240-595-9415
  • Fax:
Mailing address:
  • Phone: 240-595-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34365
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: