Irena Morin Fedorovsky, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810005119 Issued in VA

Practice address

3040 Williams Dr
Suite # 402
Fairfax, VA 22031-4618

Phone

(703) 573-3573

Fax

(703) 573-3574

NPI assigned

Jul 7, 2015

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 10, 2020 through Dec 10, 2026

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Barry B Ekdom PHD, PC

  dba Ekdom Neuropsychology Group

  • Clinical Neuropsychologist
  • Fairfax, VA
  • NPI 1194804914
  NPD (past)

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436227200000",
    "number": "1346623576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 WILLIAMS DR",
            "address_2": "SUITE # 402",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314618",
            "telephone_number": "703-573-3573",
            "fax_number": "703-573-3574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 WILLIAMS DR",
            "address_2": "SUITE # 402",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314618",
            "telephone_number": "703-573-3573",
            "fax_number": "703-573-3574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDOROVSKY",
        "first_name": "IRENA",
        "middle_name": "MORIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005119",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "05524",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "DC",
            "license": "PSY1001033",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ali Fazel, M.D.
• Susan Fazilat
• Claudia Andrea Febres Mormontoy
• Peter Jay Fecanin, M.D.
• Jay Mitchell Feder, MD
• Laura Feibelman
• Joshua Fein, D.D.S.
• Judy D. Feingold, OTR/L
• Jasmine Felder
• Maria Ann Feldpausch, RN

• Clinical Psychologist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.