Provider Demographics
NPI:1437254901
Name:RAINWATER, GILES DEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GILES
Middle Name:DEAN
Last Name:RAINWATER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 FRONT ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7360
Mailing Address - Country:US
Mailing Address - Phone:321-729-0080
Mailing Address - Fax:321-951-9508
Practice Address - Street 1:2210 FRONT ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7360
Practice Address - Country:US
Practice Address - Phone:321-729-0080
Practice Address - Fax:321-951-9508
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002525103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF66124Medicare UPIN
FL75083Medicare ID - Type Unspecified