EBTISAM FADDOUL (Credential# 2058155) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is June 23, 2020. The license expiration date date is February 28, 2021. The license status is APPROVED.
EBTISAM FADDOUL is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0074627. The credential type is controlled substance registration for practitioner. The effective date is June 23, 2020. The expiration date is February 28, 2021. The business address is 175 West Ave Unit 4, Stamford, CT 06902-5511. The current status is approved.
| Licensee Name | EBTISAM FADDOUL |
| Credential ID | 2058155 |
| Credential Number | CSP.0074627 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
175 West Ave Unit 4 Stamford CT 06902-5511 |
| Business Type | INDIVIDUAL |
| Status | APPROVED - CURRENT |
| Active | 1 |
| Issue Date | 2020-06-23 |
| Effective Date | 2020-06-23 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-06-23 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 2013260 | 23.004797 | Physician Assistant | 2020-04-23 | 2020-04-23 - 2020-09-30 | ACTIVE |
| Street Address | 175 WEST AVE UNIT 4 |
| City | STAMFORD |
| State | CT |
| Zip Code | 06902-5511 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Brandon C Futrell | 175 West Ave # 6, Stamford, CT 06902-5511 | Physical Therapist Assistant | 2019-12-01 ~ 2020-11-30 |
| Villa Crest Builders LLC | 177 West Ave Unit 2, Stamford, CT 06902-5511 | New Home Construction Contractor | 2009-10-01 ~ 2011-09-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jeris Maydeli Flores | 153 Fairfield Av, Stamford, CT 06902 | Nail Technician | ~ |
| Reynaldo De La Cruz | 64 Brookside Drive, Stamford, CT 06902 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Darren J Petillo | 5 Hundley Court, Stamford, CT 06902 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
| Antonios Restaurant | 405 West Main St, Stamford, CT 06902 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Edward Smith | 184 Fairfield Ave., Stamford, CT 06902 | Home Improvement Contractor | ~ |
| Margaret A Dorrance | 24c Hamilton Court, Stamford, CT 06902 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Carolyn Maguire | 48 Nelson St, Stamford, CT 06902 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Evelyne Joassin | 17 George St., Stamford, CT 06902 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Andrea Bynoe | 34 Melrose Pl, Stamford, CT 06902 | Notary Public Appointment | 1994-04-06 ~ 1999-04-30 |
| Ravi K Ahuja | 296 Westover Rd, Stamford, CT 06902 | Architect | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06902 | |||
| City | STAMFORD |
| Zip Code | 06902 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + STAMFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Steven Kassels Md · Community Substance Abuse Center | Comm. Physicians PC/125 North Elm Street, Westfield, MA 01085 | Controlled Substance Registration for Practitioner | 2018-06-15 ~ 2019-02-28 |
| Stacy J Faddoul | 400 W 19th St, Russellville, AR 72801 | Licensed Practical Nurse | 1993-01-25 ~ 1993-09-30 |
| Ebtisam Elhussien | 22 Katie Ln, North Haven, CT 06473-2857 | Pharmacy Intern | 2018-08-16 ~ 2021-09-30 |
| Shu-i Lin | CT | Controlled Substance Registration for Practitioner | 2017-06-12 ~ 2019-02-28 |
| Min Jin Kim | 639 4th Ave Apt 5c, Brooklyn, NY 11232-1048 | Controlled Substance Registration for Practitioner | 2012-05-10 ~ 2013-02-28 |
| Arundati Rao | CT | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Hae J Kim Pa | New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2008-03-31 ~ 2009-02-28 |
| Qi Che Md | Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2006-03-01 ~ 2007-02-28 |
| Huu Duc D Luu | 630 Mix Ave Apt 6p, Hamden, CT 06514-2320 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Erin K Fee | CT | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on EBTISAM FADDOUL.
| 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).