DOUGLAS SMITH MD (Credential# 154192) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2013. The license expiration date date is February 28, 2015. The license status is INACTIVE.
DOUGLAS SMITH MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0016824. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2013. The expiration date is February 28, 2015. The business address is 407 Woodbridge St, Manchester, CT 06042. The current status is inactive.
| Licensee Name | DOUGLAS SMITH MD |
| Credential ID | 154192 |
| Credential Number | CSP.0016824 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
407 Woodbridge St Manchester CT 06042 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE |
| Effective Date | 2013-03-01 |
| Expiration Date | 2015-02-28 |
| Refresh Date | 2016-01-29 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 539413 | 1.009320 | Physician/Surgeon | 1959-03-24 | 2014-03-01 - 2015-02-28 | INACTIVE |
| Street Address | 407 WOODBRIDGE ST |
| City | MANCHESTER |
| State | CT |
| Zip Code | 06042 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jean Smith Aprn | 407 Woodbridge St, Manchester, CT 06040 | Advanced Practice Registered Nurse | 2014-09-01 ~ 2015-08-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Melissa Aiello | 118 Tudor Lane Apt. I, Manchester, CT 06042 | Licensed Clinical Social Worker | 2020-07-01 ~ 2021-06-30 |
| Michelle Carolyn Hayes | 129 Rachel Rd, Harford, CT 06042 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Guotong Quan | 348 Kennedy Road, 348 Kennedy Road, CT 06042 | Nail Technician | 2020-06-26 ~ 2022-03-31 |
| Charity Boakye | 103 Rachel Rd,unit B, Manchester, CT 06042 | Licensed Practical Nurse | ~ |
| Jordan M Kaiser | 40 Tanner St, Manchester, CT 06042 | Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Tandra Gomes | 80 Alton St., Manchester, CT 06042 | Medication Administration Certification | 2020-05-08 ~ 2022-05-07 |
| James Power | 16 Lawton Rd., Manchester, CT 06042 | Medication Administration Certification | 2018-08-03 ~ 2020-08-02 |
| Tierra Amerson | 66 Phelps Rd., Manchester, CT 06042 | Medication Administration Certification | 2018-07-02 ~ 2020-07-01 |
| Lisa A Surdam | 22 Greenwood Drive, Manchester, CT 06042 | Notary Public Appointment | 2020-06-01 ~ 2025-05-31 |
| Sharon Morin | 15 Hartland Rd, Manchester, CT 06042 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Find all Licenses in zip 06042 | |||
| City | MANCHESTER |
| Zip Code | 06042 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + MANCHESTER |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Douglas P Shore Md | 5 Durham Rd, Guilford, CT 06437 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Kareem Douglas | 740 East St Fl 2, New Britain, CT 06051-2151 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Douglas A Berv Md | 60 Washington Ave, Hamden, CT 06518 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Douglas J Fauser | 40 Old Ridgebury Rd Ste 101, Danbury, CT 06810-5119 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Douglas J Ward Pa | 24 Preston Rd, Trumbull, CT 06611-1818 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Cheyenne Douglas | 25 West Rd, Canton, CT 06019-3739 | Controlled Substance Registration for Practitioner | 2017-08-09 ~ 2019-02-28 |
| Qendresa Beqiri | 150 Douglas St, Stratford, CT 06614-2728 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Douglas R Gallo | 1 Broad St, Stamford, CT 06901-2331 | Controlled Substance Registration for Practitioner | 2019-02-14 ~ 2019-02-28 |
| Kyle Douglas | 42 Ellington St, Longmeadow, MA 01106-1430 | Controlled Substance Registration for Practitioner | 2019-05-21 ~ 2021-02-28 |
| Douglas Ziedonis Md | Cmhc, New Haven, CT 06508 | Controlled Substance Registration for Practitioner | 1999-04-09 ~ 2000-02-28 |
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| 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).