Active NPI
William Presley Keeton III, PSY.D.
- Psychologist
- California, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 05643
- Practice address
- 22593 Three Notch Rd
California, MD 20619-3054 - Phone
- (301) 862-2505
- Fax
- (301) 862-2548
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 05643 | MD | Primary |
| Clinical Psychologist | 103TC0700X | 1406 | NC |
Addresses
Primary practice location
22593 Three Notch Rd
California, MD 20619-3054
Mailing address
22593 Three Notch Rd
California, MD 20619-3054
Phone (301) 862-2505
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0426M | Other | NC | BLUE CROSS/BLUE SHIELD |
| 6000345 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
22593 Three Notch Rd
California, MD 20619-3054
3261 Old Washington Rd
Suite 1010
Waldorf, MD 20602-3228
Phone (301) 862-2505
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05643 | MD | MD | Psychologist |
| 1406 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Personalized Therapy, LLC | Psychologist | Current | Accepting new patients |
Locations
22593 Three Notch Rd
California, MD 20619
Phone (301) 862-2505
3261 Old Washington Rd
Ste 1010
Waldorf, MD 20602
Phone (301) 645-0366
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449532800000",
"number": "1932284072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22593 THREE NOTCH RD",
"city": "CALIFORNIA",
"state": "MD",
"postal_code": "206193054",
"telephone_number": "301-862-2505",
"fax_number": "301-862-2548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22593 THREE NOTCH RD",
"city": "CALIFORNIA",
"state": "MD",
"postal_code": "206193054",
"telephone_number": "301-862-2505",
"fax_number": "301-862-2548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEETON",
"first_name": "WILLIAM",
"middle_name": "PRESLEY",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2015-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "05643",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "1406",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "0426M",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000345",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in California, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.