Chad Michael Jayasekera, MA, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

24240 Issued in MN

Practice address

1645 106TH LN NW
Coon Rapids, MN 55433-4278

Phone

(651) 210-5370

NPI assigned

Dec 29, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Northeast Youth & Family Services

  • Community Health Clinic/Center
  • White Bear Lake, MN
  • NPI 1073098810
  NPD (past)
• Northeast Youth & Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Shoreview, MN
  • NPI 1639275852
  NPD (past)

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

{
    "created_epoch": "1325116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1265701775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 106TH LN NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334278",
            "telephone_number": "651-210-5370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 106TH LN NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334278",
            "telephone_number": "651-210-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAYASEKERA",
        "first_name": "CHAD",
        "middle_name": "MICHAEL",
        "credential": "MA, LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-29",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2132",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "24240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theodore A Janossy, MD
• Aziza A Jara
• Katilynne Jane Jarmon
• Cheryl Jarvis, NP
• Sophana Jayakumar, MDS, DDS
• JD Eyes, Inc
• Jekab LLC.
• Christen Jensen
• Christine C Jensen, MD
• Eric James Jensen, CRNA

• Clinical Social Worker in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.