Larissa Ann Fedak, EDD CCC-SLP BCBA-D

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-11-8515

Practice address

9500 Annapolis Rd Ste B2C2C3
Lanham, MD 20706-2060

Phone

(301) 850-1148

NPI assigned

Jan 16, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Renoxx Caregivers, Inc.

  • Community/Behavioral Health Agency
  • Lanham, MD
  • NPI 1184480121
  NPD (past)
• Renoxx Caregivers, Inc.

  • Community/Behavioral Health Agency
  • Frederick, MD
  • NPI 1730928219
  NPD (past)
• Galaxy ABA VA LLC

  • Behavior Analyst
  • Virginia Beach, VA
  • NPI 1922859685
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1235376997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4452 US HIGHWAY 421",
            "city": "PENNINGTON GAP",
            "state": "VA",
            "postal_code": "242777972",
            "telephone_number": "855-832-6727",
            "fax_number": "772-675-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 ANNAPOLIS RD STE B2C2C3",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062060",
            "telephone_number": "301-850-1148"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4452 US Highway 421",
            "address_purpose": "LOCATION",
            "city": "Pennington Gap",
            "state": "VA",
            "postal_code": "242777972",
            "country_code": "US",
            "telephone_number": "201-284-9136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FEDAK",
        "first_name": "LARISSA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "EDD CCC-SLP BCBA-D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-16",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "018241",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-11-8515",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS00572200",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235376997",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBA-D",
            "identifier": "1-11-8515",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Lynn Farrell
• Tawa Y Fasan, HHA
• Elizabeth Kenton Fasana, MT-BC, LPMT
• Samuel Ayotola Fasanmi, PHARM D
• Elizabeth Fasika, MD
• Federal Injury Care Network, LLC
• Natalia Fedkina
• Richard Jay Feldman, MD
• Fem Care Management Inc
• Zenobia Fenrick

• Behavior Analyst in Lanham, MD
• Providers in Lanham, MD by specialty
• Behavior Analyst in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.