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General NPI Number Information
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NPI Number | 1407749005
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Entity Type | Individual
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Provider Name | MAKALE KARINA FITZGERALD LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 3050 N LAKEHARBOR LN STE 248
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City | BOISE
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State | ID
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Zip | 83703-6281
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Country | US
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Telephone | 208-991-4696
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Fax |
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Provider Business Mailing Address
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Address Line | 1568 S RIVERSTONE LN APT 201
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City | BOISE
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State | ID
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Zip | 83706-4070
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Country | US
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Telephone | 435-287-5242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 45209
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW-45209
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License Number State | ID
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