Active NPI
Philip James Keddy, PH.D.
- Clinical Psychologist
- Oakland, CA
National Provider Identifier
1679768162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY8828
- Practice address
- 5625 College Ave
216
Oakland, CA 94618-1585 - Phone
- (510) 655-8824
- Fax
- (510) 845-6889
- NPI assigned
- Sep 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY8828 | CA | Primary |
Addresses
Primary practice location
5625 College Ave
216
Oakland, CA 94618-1585
Mailing address
5625 College Ave
216
Oakland, CA 94618-1585
Phone (510) 655-8824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY8828 | Other | CA | PSYCHOLOGIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2022 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY8828 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189209600000",
"number": "1679768162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5625 COLLEGE AVE",
"address_2": "216",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946181585",
"telephone_number": "510-655-8824",
"fax_number": "510-845-6889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5625 COLLEGE AVE",
"address_2": "216",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946181585",
"telephone_number": "510-655-8824",
"fax_number": "510-845-6889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEDDY",
"first_name": "PHILIP",
"middle_name": "JAMES",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-08",
"last_updated": "2007-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY8828",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST LICENSE",
"identifier": "PSY8828",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.