PHILLIP S KICK (Credential# 1068172) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2016. The license expiration date date is March 31, 2017. The license status is INACTIVE.
PHILLIP S KICK is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.050952. The credential type is physician/surgeon. The effective date is April 1, 2016. The expiration date is March 31, 2017. The business address is 3640 Main St Ste 103, Springfield, MA 01107-1139. The current status is inactive.
| Licensee Name | PHILLIP S KICK |
| Credential ID | 1068172 |
| Credential Number | 1.050952 |
| Credential Type | Physician/Surgeon |
| Business Address |
3640 Main St Ste 103 Springfield MA 01107-1139 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2012-05-24 |
| Effective Date | 2016-04-01 |
| Expiration Date | 2017-03-31 |
| Refresh Date | 2017-07-04 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1082625 | CSP.0053148 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2012-07-13 | 2015-03-01 - 2017-02-28 | INACTIVE |
| Street Address | 3640 MAIN ST STE 103 |
| City | SPRINGFIELD |
| State | MA |
| Zip Code | 01107-1139 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| William C Tran | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | 2014-08-01 ~ 2015-07-31 |
| Mohammad R Mostafavi | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | ~ |
| Donald J Sonn | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | ~ |
| Alexander M. Berry | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | ~ |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Susan D Glover | 3640 Main Street, Springfield, MA 01107-1139 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Brian K Bredvik | 3640 Main St Ste 205, Springfield, MA 01107-1139 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Mark A Jackowitz | 3640 Main St Ste 205, Springfield, MA 01107-1139 | Physician/surgeon | 2020-01-01 ~ 2020-12-31 |
| Philip Moraitis | 3640 Main St Ste 205, Springfield, MA 01107-1139 | Physician/surgeon | 2016-05-01 ~ 2017-04-30 |
| Gregory J Faust | 3640 Main St Ste 205, Springfield, MA 01107-1139 | Physician/surgeon | 2014-04-01 ~ 2015-03-31 |
| Raphael J De Lima | 3640 Main Street, Springfield, MA 01107-1139 | Physician/surgeon | 2008-10-14 ~ 2009-10-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Lauren Elizabeth Marshall | 945 Armory St, Springfield, MA 01107 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Jennifer L Fish | 367 Union Street, Springfield, MA 01107 | Hairdresser/cosmetician | ~ |
| Joseph Pagan | 59 Rowland Street, Springfield, MA 01107 | Medication Administration Certification | 2020-04-20 ~ 2022-04-19 |
| Daniel Laguerre | 382 Springfield St, Springfield, MA 01107 | Crane Operator | ~ |
| Kamal Kant Kalia | 2 Medical Center Drive, Springfield, MA 01107 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Bushee Enterprises LLC | Po Box 1196, Southwick, MA 01107 | Home Improvement Contractor | 2015-12-01 ~ 2016-11-30 |
| B Lopez | 165 Prospect Street, Springfield, MA 01107 | Notary Public Appointment | 2011-10-01 ~ 2016-09-30 |
| Beth C Mcinerny | 260 Ware Road, Belchertown, MA 01107 | Registered Nurse | 2019-12-01 ~ 2020-11-30 |
| Jorge Enrique Rivera | 20 Narragansett Street, Springfield, MA 01107 | Professional Counselor | 2019-10-01 ~ 2020-09-30 |
| Rachael Hynds-decoteau | 22 Candice Cir, Springfield, MA 01107 | Controlled Substance Registration for Practitioner | 2019-09-19 ~ 2021-02-28 |
| Find all Licenses in zip 01107 | |||
| City | SPRINGFIELD |
| Zip Code | 01107 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + SPRINGFIELD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Phillip F Pierce Jr | 3 Fox Den Way, Woodbridge, CT 06525 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
| Martin Phillip Kasofsky | Po Box 466, Stanfordville, NY 12581-0466 | Physician/surgeon | 1990-09-28 ~ 1992-02-29 |
| Phillip I Menasche | 19 Truman St, Norwalk, CT 06850-3641 | Physician/surgeon | ~ 1986-04-30 |
| Phillip Dickey Md | 60 Temple Street, New Haven, CT 06510 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Phillip Andrus Md | 14 Lefurgy Ave, Hastings-on-hudson, NY 10706 | Physician/surgeon | 2019-10-07 ~ 2020-09-30 |
| Jeffrey Phillip Calender | 111 Wendover Rd, Suffield, CT 06078 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Phillip P Smith | 5 Willow Lane, Farmington, CT 06032 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Phillip E Trowbridge | 10 Upper Heatherwood, Cromwell, CT 06416 | Physician/surgeon | 2006-10-23 ~ 2007-10-31 |
| Phillip Y Roland Md | 22 Arrowwood Lane, Bloomfield, CT 06002 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Phillip H Kuo | 2225 E Hampton Street, Tucson, AZ 85719 | Physician/surgeon | 2009-10-01 ~ 2010-09-30 |
Please comment or provide details below to improve the information on PHILLIP S KICK.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).