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Organization
PERFECTLY IMPERFECT
Active
Organization
PERFECTLY IMPERFECT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIC CAGLIOSTRO LCSW, LADAC (OWNER)
(505) 550-1306
Entity
Organization
Contact information
Practice address
146 QUINCY ST NE, ALBUQUERQUE, NM 87108
(505) 550-1306
(844) 434-8055
Mailing address
4720 PERSHING AVE SE, ALBUQUERQUE, NM 87108-3438
(505) 220-5481
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34155384
—
NM
Enumeration date
12/08/2014
Last updated
09/05/2018
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