Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Erick Jonathan Fedorenko, PHD

Individual provider Clinical Psychologist · NPI 1558253369

Erick Jonathan Fedorenko, PHD is a Clinical Psychologist in Providence, Rhode Island. Qualified in 2023, 3 years ago. Practices with Affinity Physicians LLC, a 734-clinician group and accepts Medicare assignment. Licensed in Rhode Island.

Years since qualifying
3
Licensed in
RI
In the registry since
2025
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

345 Blackstone Blvd
Providence, RI 02906-4800
Phone: (401) 455-6200
Fax: (401) 455-6689
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence PS02387 (RI)

Record details

NPI number1558253369
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedJuly 16, 2025
Last updated in NPPESAugust 25, 2025
Certification dateAugust 25, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Affinity Physicians Llc. — 734 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Providence