Provider Demographics
NPI:1851126049
Name:BURKHARDT, CAROLINE (LCSW-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:BURKHARDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:799 MARTIN CT W
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2214
Mailing Address - Country:US
Mailing Address - Phone:443-336-3547
Mailing Address - Fax:
Practice Address - Street 1:2009 TIDEWATER COLONY DR STE 2A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2111
Practice Address - Country:US
Practice Address - Phone:443-261-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD231941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical