Provider Demographics
NPI:1982825337
Name:RAINER, DEIRDRE DANETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:DANETTE
Last Name:RAINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3633
Mailing Address - Country:US
Mailing Address - Phone:307-349-5027
Mailing Address - Fax:307-335-9973
Practice Address - Street 1:550 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3089
Practice Address - Country:US
Practice Address - Phone:307-349-5027
Practice Address - Fax:307-335-9973
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY342103TC0700X
CAPSY 9892103TC0700X
HIPSY 1239103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118897600Medicaid
WY310889Medicare UPIN