MEDICARE: JAITHRA JAYAKRISHNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	37PC00829300	NJ
3	101YP2500X	Professional Counselor	PC009108	PA

General Provider Information

NPI Number	:	1134576341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAITHRA JAYAKRISHNAN

Provider Business Mailing Address
First Line	:	4301 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2719
Country	:	US
Telephone Number	:	347-777-7353
Fax Number	:	267-332-5175

Provider Business Practice Location Address
First Line	:	4301 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2719
Country	:	US
Telephone Number	:	267-296-7231
Fax Number	:	267-332-5175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2016
Last Update Date	:	05/28/2024

Similar Medicare Providers

1750238630 — WANDA R RAMIREZ MD
Practice Location Address:

4301 RISING SUN AVE
PHILADELPHIA, PA
19140-2719

Practice Phone: 914-708-8677
Practice Fax:

1174735518 — DR. NEMESIA G. CASTRO M.D.
Practice Location Address:

4301 RISING SUN AVE
PHILADELPHIA, PA
19140-2719

Practice Phone: 215-456-1453
Practice Fax: 215-456-1489

1497932479 — ASOCIACION DE PUERTORRIQUENOS EN MARCHA, INC.
Practice Location Address:

4301 RISING SUN AVE
PHILADELPHIA, PA
19140-2719

Practice Phone: 267-296-7220
Practice Fax: 215-324-1153

1508132119 — HECTOR COLON-RIVERA MBA, MD
Practice Location Address:

4301 RISING SUN AVE
PHILADELPHIA, PA
19140-2719

Practice Phone: 267-296-7220
Practice Fax: 203-781-4624

1932107810 — LAWRENCE D KASSAN D.P.M.
Practice Location Address:

2101 SNYDER AVE
PHILADELPHIA, PA
19145-2719

Practice Phone: 215-336-4151
Practice Fax: 215-336-5111

1508843459 — JANINE M. STOFFEY LCSW
Practice Location Address:

5675 N FRONT ST
PHILADELPHIA, PA
19120-2719

Practice Phone: 215-279-9666
Practice Fax: 215-279-9674

Directions to “ JAITHRA JAYAKRISHNAN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.