MARY BETH VAN SICLEN (Credential# 1496698) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2020. The license expiration date date is March 31, 2021. The license status is ACTIVE.
MARY BETH VAN SICLEN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.061380. The credential type is physician/surgeon. The effective date is April 1, 2020. The expiration date is March 31, 2021. The business address is 180 Barbara Rd, Middletown, CT 06457-2404. The current status is active.
| Licensee Name | MARY BETH VAN SICLEN |
| Credential ID | 1496698 |
| Credential Number | 1.061380 |
| Credential Type | Physician/Surgeon |
| Business Address |
180 Barbara Rd Middletown CT 06457-2404 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2018-06-18 |
| Effective Date | 2020-04-01 |
| Expiration Date | 2021-03-31 |
| Refresh Date | 2020-03-10 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1598961 | CSP.0069513 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2018-09-11 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 180 BARBARA RD |
| City | MIDDLETOWN |
| State | CT |
| Zip Code | 06457-2404 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mary Beth E Van Siclen | 180 Barbara Rd, Middletown, CT 06457-2404 | Controlled Substance Registration for Practitioner | 2018-04-04 ~ 2019-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elizabeth M Mailhot | 177 Timber Ridge Rd, Middletown, CT 06457 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Rebecca S Fennessy | 22 Keefe Ln, Middletown, CT 06457 | Licensed Clinical Social Worker | 2020-07-01 ~ 2021-06-30 |
| Eloise M Gagnon | 538 Bow Lane, Middletown, CT 06457 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Salvatore Dimauro | 245 Dekoven Dr, Middletown, CT 06457 | Public Weigher | 2020-07-01 ~ 2021-06-30 |
| Frank L Wright | 261 Spencer Dr, Middletown, CT 06457 | Barber | 2020-08-01 ~ 2022-07-31 |
| Gino A Cardella | 50 Sonoma Lane, Middletown, CT 06457 | Real Estate Salesperson | ~ |
| Shannon Lee Mcquillan | 5 Forest Glen Circle, Middletown, CT 06457 | Registered Nurse | 2020-06-26 ~ 2020-09-30 |
| Lori Dimauro · Carta | 244 Chamberlain Hill Road, Middletown, CT 06457 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Gail A Corrow | 85 Dora Dr, Middletown, CT 06457 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Mariter V Perez | 8 Moss Glen, Middletown, CT 06457 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06457 | |||
| City | MIDDLETOWN |
| Zip Code | 06457 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + MIDDLETOWN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mary Beth E Van Siclen | 180 Barbara Rd, Middletown, CT 06457-2404 | Controlled Substance Registration for Practitioner | 2018-04-04 ~ 2019-02-28 |
| Mary Beth Friel | 799 Bloomfield Ave, Suite 201, Verona, NJ 07044 | Physician/surgeon | ~ |
| Mary Beth Janicki Md | 52 Orchard Rd, West Hartford, CT 06117 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Mary Beth Harman | 5520 Park Ave., Trumbull, CT 06611 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Mary Beth C Ellison | 11 Wildwood Medical Center, Essex, CT 06426 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Mary Beth Spillane · Mary Beth Abram | 145 Carriage Way, Windsor, CT 06095 | Registered Nurse | 2019-12-01 ~ 2020-11-30 |
| Mary Beth Chinsky · Mary Beth's Home Day Care | 15 Sunrise Ln, South Windsor, CT 06074-2060 | Family Child Care Home | 2018-02-01 ~ 2022-01-31 |
| Beth Duncan | 509 Falkirk Rd, Wilmington, DE 19803 | Physician/surgeon | ~ |
| Beth A Leeman Markowski | Apt 523, Washington, DC 20016 | Physician/surgeon | ~ |
| Beth Prinz | 79 South End Rd. | Physician/surgeon | 2002-04-08 ~ 2003-04-30 |
Please comment or provide details below to improve the information on MARY BETH VAN SICLEN.
| 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).