NPIMap

Organization Active NPI

Perfectly Imperfect

  • Mental Health Counselor
  • Albuquerque, NM
National Provider Identifier
1720486772
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PERFECTLY IMPERFECT
Practice address
146 Quincy St NE
Albuquerque, NM 87108
Phone
(505) 550-1306
Fax
(844) 434-8055
NPI assigned
Dec 8, 2014
Last updated
Sep 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

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

Authorized official

Name
Dominic Cagliostro, LCSW, LADACNPI 1417281890
Title
Owner
Phone
(505) 550-1306

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

146 Quincy St NE
Albuquerque, NM 87108

Mailing address

4720 Pershing Ave SE
Albuquerque, NM 87108-3438
Phone (505) 220-5481

Other identifiers 1

IdentifierTypeStateIssuer
34155384MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170922001558 NM Part B Supplier - Clinic/Group Practice 3577837905 Receives reassigned benefits from 3 practitioners
Practice locations: Albuquerque, NM

National Provider Directory

National Provider Directory
Tax ID family
Perfectly Imperfect2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

146 Quincy St NE
Albuquerque, NM 87108
Phone (505) 550-1306

148 Quincy St NE
Albuquerque, NM 87108
Phone (505) 220-5481

149 Jackson St NE
Albuquerque, NM 87108
Phone (505) 550-1306

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536105600000",
    "number": "1720486772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 PERSHING AVE SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871083438",
            "telephone_number": "505-220-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 QUINCY ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87108",
            "telephone_number": "505-550-1306",
            "fax_number": "844-434-8055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFECTLY IMPERFECT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-08",
        "last_updated": "2018-09-05",
        "status": "A",
        "authorized_official_last_name": "CAGLIOSTRO",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-550-1306",
        "authorized_official_credential": "LCSW, LADAC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34155384",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.