Provider Demographics
NPI:1407749005
Name:FITZGERALD, MAKALE KARINA (LMSW)
Entity type:Individual
Prefix:
First Name:MAKALE
Middle Name:KARINA
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 S RIVERSTONE LN APT 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-4070
Mailing Address - Country:US
Mailing Address - Phone:435-287-5242
Mailing Address - Fax:
Practice Address - Street 1:3050 N LAKEHARBOR LN STE 248
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6281
Practice Address - Country:US
Practice Address - Phone:208-991-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID452091041C0700X
IDLMSW-452091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical