MEDICARE: PERFECT PIECE LLC

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
1	251S00000X	Community/Behavioral Health Agency	1-10-7448	MA

General Provider Information

NPI Number	:	1659732535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFECT PIECE LLC

Provider Business Mailing Address
First Line	:	150 WASHINGTON AVE
Second Line	:	201
City	:	SANTA FE
State	:	NM
Zip	:	87501-2073
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 WASHINGTON AVE
Second Line	:	201
City	:	SANTA FE
State	:	NM
Zip	:	87501-2073
Country	:	US
Telephone Number	:	508-733-6392
Fax Number	:

Authorized Official
Title or Position	:	BCBA/OWNER
Name	:	MATOTOPA AUGUSTINE
Credential	:	M.S, BCBA
Telephone Number	:	508-733-6392

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	03/18/2016

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