MEDICARE: EMANUEL PEREDA

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1750213971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMANUEL PEREDA

Provider Business Mailing Address
First Line	:	4821 HARLAN AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 TRAIL LAKE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2030
Country	:	US
Telephone Number	:	817-380-8115
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ EMANUEL PEREDA ” Practice Location

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