Individual provider Active NPI

Tiarah Marie Funderburk, LMSW

  • Social Worker
  • Baltimore, MD
National Provider Identifier
1740870450
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
26353 Issued in MD
Practice address
5820 York Rd
Baltimore, MD 21212-3610
Phone
(301) 345-1022
NPI assigned
Jan 26, 2021
Last updated
Jan 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X MD
Social Worker 104100000X 26353 MD Primary

Addresses

Primary practice location

5820 York Rd
Baltimore, MD 21212-3610

Mailing address

1003 W 7TH St Ste 500
Frederick, MD 21701-8512
Phone (301) 345-1022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230601001842 MD Practitioner - Clinical Social Worker 9133586480 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Safe Harbor Behavioral Care LLCGroup PAC ID 0345514675, 81 clinicians

Practice addresses (Care Compare)

5430 Campbell Blvd
Suite 211
White Marsh, MD 21162-5504
Phone (410) 893-4600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26353MDMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Behavioral Health, Inc CurrentSince Nov 3, 2024 Accepting new patients
Safe Harbor Behavioral Care, LLC Social Worker CurrentSince Jan 1, 2025 Accepting new patients
Health First Primary Care, LLC Past Accepting new patients

Locations

5820 York Rd
Baltimore, MD 21212
Phone (410) 532-3080

1208 E Churchville Rd
Ste 300
Bel Air, MD 21014
Phone (410) 838-9500

1003 W 7th St
Ste 500
Frederick, MD 21701
Phone (240) 297-1567

5430 Campbell Blvd
Ste 211
White Marsh, MD 21162
Phone (410) 838-9500

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1740870450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 W 7TH ST STE 500",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217018512",
            "telephone_number": "301-345-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5820 YORK RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212123610",
            "telephone_number": "301-345-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDERBURK",
        "first_name": "TIARAH",
        "middle_name": "MARIE",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-26",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "26353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.