MEDICARE: ANNA R PEREIDA LMSW, LCDC

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	104100000X	Social Worker	57450	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	12174	TX

General Provider Information

NPI Number	:	1346584851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA R PEREIDA LMSW, LCDC

Provider Business Mailing Address
First Line	:	351 W JEFFERSON BLVD STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-7860
Country	:	US
Telephone Number	:	214-521-5191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 PEABODY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-2821
Country	:	US
Telephone Number	:	214-421-7848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	03/10/2015

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