| Perfectly Imperfect | |
|
146 Quincy St Ne Albuquerque NM 87108 | |
| (505) 550-1306 | |
| (844) 434-8055 |
| Full Name | Perfectly Imperfect |
|---|---|
| Speciality | Counselor |
| Location | 146 Quincy St Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Dominic Cagliostro (OWNER) |
| Authorized Official Contact | 5055501306 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Perfectly Imperfect 4720 Pershing Ave Se Albuquerque NM 87108-3438 Ph: (505) 220-5481 | Perfectly Imperfect 146 Quincy St Ne Albuquerque NM 87108 Ph: (505) 550-1306 |
| NPI Number | 1720486772 |
|---|---|
| Provider Enumeration Date | 12/08/2014 |
| Last Update Date | 09/05/2018 |
| Medicare PECOS PAC ID | 3577837905 |
|---|---|
| Medicare Enrollment ID | O20170922001558 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720486772 | NPI | - | NPPES |
| 34155384 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Dominic Cagliostro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417281890 PECOS PAC ID: 4486928819 Enrollment ID: I20170925000495 |
| Provider Name | Desiree R Ramirez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356674592 PECOS PAC ID: 3577991447 Enrollment ID: I20200309001053 |
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