PHYLLIS E HEADLEY (Credential# 144389) 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 ACTIVE.
PHYLLIS E HEADLEY is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0009495. 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 23 Eastview Drive, New Fairfield, CT 06812. The current status is active.
| Licensee Name | PHYLLIS E HEADLEY |
| Credential ID | 144389 |
| Credential Number | CSP.0009495 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
23 Eastview Drive New Fairfield CT 06812 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-15 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 544034 | 1.022213 | Physician/Surgeon | 1980-06-25 | 2020-02-01 - 2021-01-31 | ACTIVE |
| Street Address | 23 EASTVIEW DRIVE |
| City | NEW FAIRFIELD |
| State | CT |
| Zip Code | 06812 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elizabeth Pepin | 16 Cloverleaf Drive, New Fairfield, CT 06812 | Notary Public Appointment | ~ |
| Antoinett L Crawford | 60 Beaver Bog, New Fairfield, CT 06812 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Goodie Shoppe LLC (the) | 1 Brush Hill Rd, New Fairfield, CT 06812 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Jeffrey R Logel · Fairwood Wine & Liquor | 17 Route 39 Shaw's Plaza, New Fairfield, CT 06812 | Package Store Liquor | 2020-08-11 ~ 2021-08-10 |
| Joseph G Dimyan | 1 Lloyd Avenue, New Fairfield, CT 06812 | Real Estate Salesperson | 2020-06-24 ~ 2021-05-31 |
| Melanie Porter | 2 High Trail Ci Rd, New Fairfield, CT 06812 | Behavior Analyst | 2020-07-01 ~ 2021-06-30 |
| Dara E O'toole | 15 Muller Street, New Fairfield, CT 06812 | Radiographer | 2020-08-01 ~ 2021-07-31 |
| Anita Michelle Thompson | 15 Bauer Road, New Fairfield, CT 06812 | Registered Nurse | ~ |
| Maureen Salerno · Schully | 4 Old Orchard Road, New Fairfield, CT 06812 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
| John N Devito IIi IIi | 9 Cloverleaf Drive, New Fairfield, CT 06812 | Notary Public Appointment | 2020-10-01 ~ 2025-09-30 |
| Find all Licenses in zip 06812 | |||
| City | NEW FAIRFIELD |
| Zip Code | 06812 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + NEW FAIRFIELD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Annette L Headley Md · Seaport Walk-in Medical Center | 56 Whitehall Avenue, Mystic, CT 06355 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phyllis A Liu Od | 264 Amity Rd Ste 212, Woodbridge, CT 06525-2200 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phyllis A Young | 8 Rue De Vin Dr, Marlboro, NY 12542-5953 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phyllis Lungelow Pa | 53 Fieldstone Rd, Waterbury, CT 06704 | Controlled Substance Registration for Practitioner | 2002-03-05 ~ 2003-02-28 |
| Phyllis Tawiah | 151 Courtland Ave Apt 2c, Stamford, CT 06902-9104 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Daniel Demesh | 21 Phyllis Ct, Staten Island, NY 10309-4313 | Controlled Substance Registration for Practitioner | 2020-05-21 ~ 2021-02-28 |
| Phyllis A Syres Dvm | 227 Gurleyville Rd Apt B, Storrs Mansfield, CT 06268-1448 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phyllis Chen Md | 1292 Old Waterbury Rd, Southbury, CT 06488 | Controlled Substance Registration for Practitioner | 1996-03-01 ~ 1997-02-28 |
| Phyllis G Grable-esposito | 85 Seymour Street, Hartford, CT 06106 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phyllis Beveridge Aprn | 6 Lord Brook, Cromwell, CT 06416 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on PHYLLIS E HEADLEY.
| 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).