KEITH CORL (Credential# 1687682) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is September 12, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
KEITH CORL is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0072311. The credential type is controlled substance registration for practitioner. The effective date is September 12, 2019. The expiration date is February 28, 2021. The business address is 22 Ogden St, Providence, RI 02906-4904. The current status is active.
| Licensee Name | KEITH CORL |
| Credential ID | 1687682 |
| Credential Number | CSP.0072311 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
22 Ogden St Providence RI 02906-4904 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-09-12 |
| Effective Date | 2019-09-12 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-09-16 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1656538 | 1.064223 | Physician/Surgeon | 2019-09-12 | 2019-09-12 - 2020-09-30 | ACTIVE |
| Street Address | 22 OGDEN ST |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02906-4904 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| The Stephen C. Rose Legacy Foundation · The Steve Fund | 138 Governor Street, Providence, RI 02906 | Public Charity | 2020-06-12 ~ 2021-11-30 |
| Moriah Connor | 211 Waterman Street, Unit 20, Providence, RI 02906 | Behavior Analyst | ~ |
| Elizabeth Burns | 198 Camp Street, Providence, RI 02906 | Licensed Clinical Social Worker | ~ |
| Christine Montross | 345 Blackstone Blvd, Providence, RI 02906 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Susan Dickstein | 196 Freeman Parkway, Providence, RI 02906 | Psychologist | 2020-07-01 ~ 2021-06-30 |
| Victoria S Karlsen | 415 Angell St, Providence, RI 02906 | Behavior Analyst | ~ |
| John W O'bell Md | 14 Rose Ct., Providence, RI 02906 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Alexandria Hanul Simon | 323 Angell Street, Providence, RI 02906 | Emergency Medical Technician | ~ |
| Molly A Moran | 202 Sixth Street, Providence, RI 02906 | Advanced Practice Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Simon M Cornelissen | 45 Balton Rd, Providence, RI 02906 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Find all Licenses in zip 02906 | |||
| City | PROVIDENCE |
| Zip Code | 02906 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + PROVIDENCE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Keith P Cross | 925 Mix Ave Apt 1-h, Hamden, CT 06514 | Controlled Substance Registration for Practitioner | 2007-03-01 ~ 2008-02-29 |
| Keith Hollinger | 55 Nye Rd Ste 101, Glastonbury, CT 06033-1281 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith A Hopkins Md | 5 Perryridge Rd, Greenwich, CT 06830 | Controlled Substance Registration for Practitioner | 2006-03-01 ~ 2007-02-28 |
| Keith M Lemire | 741 Broad St Ext, Waterford, CT 06385 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith Rosenberg | 111 West St, Portland, ME 04102-3416 | Controlled Substance Registration for Practitioner | 2019-06-20 ~ 2021-02-28 |
| Matthew P Ward | 47 Keith Cir, Killingworth, CT 06419-1453 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith Vom Eigen Md | 131 Coventry St, Hartford, CT 06112 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith L Ellis | 16 Spring St, Chester, CT 06412-1335 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith P Meslin | 265 Slater St 220, Manchester, CT 06040 | Controlled Substance Registration for Practitioner | 2005-03-01 ~ 2006-02-28 |
| Keith A Landesman Md | 39 Ridge Rd, Weston, CT 06883 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
Please comment or provide details below to improve the information on KEITH CORL.
| 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).