LYDIA WALLACE (Credential# 1296798) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is INACTIVE.
LYDIA WALLACE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0060796. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 289 Green St, Boston, MA 02130-2660. The current status is inactive.
| Licensee Name | LYDIA WALLACE |
| Credential ID | 1296798 |
| Credential Number | CSP.0060796 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
289 Green St Boston MA 02130-2660 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LACK OF ACTIVE MEDICAL LICENSE |
| Issue Date | 2015-06-29 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-04-23 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1492172 | 1.059907-RES | Resident Physician | 2017-07-01 | 2018-07-01 - 2019-06-30 | INACTIVE |
| Street Address | 289 GREEN ST |
| City | BOSTON |
| State | MA |
| Zip Code | 02130-2660 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Cynthia Ann Nichols | 3611 Washington Street Unit B627, Boston, MA 02130 | Licensed Clinical Social Worker | 2020-08-01 ~ 2021-07-31 |
| Claire L Fellman | 90 Forest Hill St #3, Jamaica Plain, MA 02130 | Landscape Architect | 2019-01-30 ~ 2019-07-31 |
| Ginger Mills | 150 South Huntington Avenue, Boston, MA 02130 | Psychologist | ~ |
| Paolo Bidin | 227a Lamartine Street, Jamaica Plain, MA 02130 | Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Joaquin Q Camara-quintana | 101 South Huntington Ave, Jamaica Plain, MA 02130 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Community Servings · Pie In The Sky | 18 Marbury Terrace, Jamaica Plain, MA 02130 | Public Charity | 2020-06-01 ~ 2021-05-31 |
| Michael J Hart | 28 Grovenor Rd, Jamaica Plain, MA 02130 | Temporary Certified General Real Estate Appraiser | 2019-09-03 ~ 2020-03-03 |
| Lauren L Forni | 3611 Washington Street Unit B430, Boston, MA 02130 | Pharmacist | 2020-02-03 ~ 2022-01-31 |
| Jill Canora | 3 Edge Hill St, Boston, MA 02130 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| Shannon F Manzi | 202 Chestnut Ave, Jamaica Plain, MA 02130 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| Find all Licenses in zip 02130 | |||
| City | BOSTON |
| Zip Code | 02130 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + BOSTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Lydia S Dugdale Md | 27 Laurel Rd, Hamden, CT 06517 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Lydia M Hunt | 20 York St, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2019-05-28 ~ 2021-02-28 |
| Lydia Lormand | 7 Heritage Dr, Bolton, CT 06043 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Lydia S Segui | 32 Broc Ter, Shelton, CT 06484-4204 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Carol Lydia Wiediger | 142 Williamstown Court, Newington, CT 06111 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Lydia Aoun-barakat | 26 Davis Road, Woodbridge, CT 06525 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| E F Wallace Dvm | Torrington Rd, Litchfield, CT 06759 | Controlled Substance Registration for Practitioner | 1994-04-15 ~ 1996-05-01 |
| Lydia A Chwastiak Md | Connecticut Mental Health Center, New Haven, CT 06519 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Suemoy Wallace | 80 Seymour St, Hartford, CT 06102-8000 | Controlled Substance Registration for Practitioner | 2009-09-14 ~ 2011-02-28 |
| Richard B Wallace Md | 7 Devonshire Dr, Waterford, CT 06385-1701 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
Please comment or provide details below to improve the information on LYDIA WALLACE.
| 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).