Provider Demographics
NPI:1346623576
Name:FEDOROVSKY, IRENA MORIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:IRENA
Middle Name:MORIN
Last Name:FEDOROVSKY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 WILLIAMS DR
Mailing Address - Street 2:SUITE # 402
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:703-573-3573
Mailing Address - Fax:703-573-3574
Practice Address - Street 1:3040 WILLIAMS DR
Practice Address - Street 2:SUITE # 402
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4618
Practice Address - Country:US
Practice Address - Phone:703-573-3573
Practice Address - Fax:703-573-3574
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005119103TC0700X
MD05524103TC0700X
DCPSY1001033103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical