DAVID J FREDERIKS (Credential# 196333) 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.
DAVID J FREDERIKS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0026938. 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 79 Neck Rd, Old Lyme, CT 06371. The current status is active.
| Licensee Name | DAVID J FREDERIKS |
| Credential ID | 196333 |
| Credential Number | CSP.0026938 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
79 Neck Rd Old Lyme CT 06371 |
| 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 | 2019-02-08 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 554402 | 1.036811 | Physician/Surgeon | 1998-04-24 | 2019-10-01 - 2020-09-30 | ACTIVE |
| Street Address | 79 NECK RD |
| City | OLD LYME |
| State | CT |
| Zip Code | 06371 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| E Russell Learned | 82 Norwich-salem Rd, Lyme, CT 06371 | Architect | 2020-08-01 ~ 2021-07-31 |
| Joann M Reis | 75 Swan Ave, Old Lyme, CT 06371 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Michele K Griswold | 7 Osprey Road, Old Lyme, CT 06371 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Brenda A Moriarty | 53 Brown's Lane, Old Lyme, CT 06371 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Olaf J Ogland | 17 Jericho Drive, Old Lyme, CT 06371 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Anne Burns | 60 Saltaire Drive, Old Lyme, CT 06371 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Lori A Volles | 67 Sterling Hill Rd, Lyme, CT 06371 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Derek J Lachance | 7 Sunset Drive, Old Lyme, CT 06371 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Vincenzo Jerome Marafito | 14-1 Bailey Rd, Old Lyme, CT 06371 | Master's Level Social Worker | ~ |
| All Pro Automotive | 147 Boston Post Rd, Old Lyme, CT 06371 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06371 | |||
| City | OLD LYME |
| Zip Code | 06371 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + OLD LYME |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| David F Lee Dds | 521 3rd Ave Apt 2, New York, NY 10016-4747 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| David Cone Md | 58 Middletown Ave, New Haven, CT 06513 | Controlled Substance Registration for Practitioner | 2003-07-02 ~ 2004-02-28 |
| David A Williams | David Williams Aprn, Danbury, CT 06488 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| David P Nocek Md | David Nocek, Greenwich, CT 06831-5100 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| David C Lo | 21 South St, Ridgefield, CT 06877 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| David Ryu | 24 Hospital Ave, Danbury, CT 06810-6099 | Controlled Substance Registration for Practitioner | 2011-04-22 ~ 2013-02-28 |
| David J Sikowitz | Po Box 351, Middletown, CT 06457 | Controlled Substance Registration for Practitioner | 1993-02-01 ~ 1995-02-01 |
| David H Hsi | Po Box 9317, Stamford, CT 06904-9317 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| David Yan Md | 140 Sherman St Fl 3, Fairfield, CT 06824-5849 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| David Cardaropoli | 260 Elm St, Enfield, CT 06082-3113 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
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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).