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NPI Code Detail

MEDICARE: MAKALE KARINA FITZGERALD LMSW

MEDICARE: MAKALE KARINA FITZGERALD LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker45209ID
21041C0700XClinical Social WorkerLMSW-45209ID

General Provider Information

NPI Number : 1407749005
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKALE KARINA FITZGERALD LMSW
Provider Business Mailing Address
First Line : 1568 S RIVERSTONE LN APT 201
Second Line :
City : BOISE
State : ID
Zip : 83706-4070
Country : US
Telephone Number : 435-287-5242
Fax Number :
Provider Business Practice Location Address
First Line : 3050 N LAKEHARBOR LN STE 248
Second Line :
City : BOISE
State : ID
Zip : 83703-6281
Country : US
Telephone Number : 208-991-4696
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2025
Last Update Date : 06/02/2025

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