AMY MARIE DOUGLASS (Credential# 1666940) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is June 7, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
AMY MARIE DOUGLASS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0071447. The credential type is controlled substance registration for practitioner. The effective date is June 7, 2019. The expiration date is February 28, 2021. The business address is 28 Crescent St, Middletown, CT 06457-3654. The current status is active.
| Licensee Name | AMY MARIE DOUGLASS |
| Credential ID | 1666940 |
| Credential Number | CSP.0071447 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
28 Crescent St Middletown CT 06457-3654 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-06-07 |
| Effective Date | 2019-06-07 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-06-10 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1643076 | 1.063602 | Physician/Surgeon | 2019-06-05 | 2019-11-01 - 2020-10-31 | ACTIVE |
| Street Address | 28 CRESCENT ST |
| City | MIDDLETOWN |
| State | CT |
| Zip Code | 06457-3654 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mark R Jonker | 28 Crescent St, Middletown, CT 06457 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| William H Zeidler Jr Md | 28 Crescent St, Middletown, CT 06457-3654 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Middlesex Hospital | 28 Crescent St, Middletown, CT 06457 | Controlled Substance Registration for Hospitals | 2019-03-01 ~ 2021-02-28 |
| Kristine Doyle | 28 Crescent St, Middletown, CT 06457-3654 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Komal Sharma | 28 Crescent St, Middletown, CT 06457 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Cortney Katz | 28 Crescent St, Middletown, CT 06457 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Ying Zheng Pa | 28 Crescent St, Middletown, CT 06457-3654 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Ruxandra Pascanu | 28 Crescent St, Middletown, CT 06457 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Cathy Zack | 28 Crescent St, Middletown, CT 06457-3654 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Laura V Pittari | 28 Crescent St, Middletown, CT 06457-3654 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Chia-chi Wang | 540 Saybrook Road, Middletown, CT 06457-3654 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Middlesex Hospital | 28 Crescent St Dept Of, Middletown, CT 06457-3654 | Licensed Ems Organization | 2020-01-01 ~ 2020-12-31 |
| Jonathan H Hall | Department of Emergency Medicine, Middletown, CT 06457-3654 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| 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 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + MIDDLETOWN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Frances A Douglass Md | 20 William St Apt 2b, Mount Vernon, NY 10552-2835 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Nathan Douglass | 888 White Plains Rd, Trumbull, CT 06611-4552 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Donna Marie Marie Romito | 330 Washington St, Norwich, CT 06360 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Marie E Didario | 31 Fox Run Ct, Newington, CT 06111-4579 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Joy Marie Richardson | 19 Day St, Norwalk, CT 06854-4912 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Marie Dam | 86 Deer Run, Burlington, CT 06013-1815 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Theresa Marie Ramponi | 928 Elm, New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2019-04-03 ~ 2021-02-28 |
| Marie Tanzer | 282 Washington St 4h, Hartford, CT 06106 | Controlled Substance Registration for Practitioner | 2008-03-03 ~ 2009-02-28 |
| Marie E Peddinghaus | 111 Park St Apt 3e, New Haven, CT 06511-5451 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Pia Marie E Ajero Md | 126 Triangle St Apt B35, Danbury, CT 06810-2912 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
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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).