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General NPI Number Information
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NPI Number | 1982825337
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Entity Type | Individual
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Provider Name | DEIRDRE DANETTE RAINER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 550 MAIN ST SUITE 4
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City | LANDER
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State | WY
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Zip | 82520-3089
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Country | US
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Telephone | 307-349-5027
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Fax | 307-335-9973
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Provider Business Mailing Address
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Address Line | 830 S 5TH ST
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City | LANDER
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State | WY
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Zip | 82520-3633
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Country | US
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Telephone | 307-349-5027
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Fax | 307-335-9973
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 342
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 9892
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 1239
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License Number State | HI
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