KELLY M DEFOREST (Credential# 392844) 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.
KELLY M DEFOREST is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0036896. 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 267 Rte 87, Columbia, CT 06237. The current status is active.
| Licensee Name | KELLY M DEFOREST |
| Credential ID | 392844 |
| Credential Number | CSP.0036896 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
267 Rte 87 Columbia CT 06237 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2004-12-28 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-04 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 567315 | 10.063305 | Registered Nurse | 2000-04-05 | 2019-10-01 - 2020-09-30 | ACTIVE |
| 681334 | 12.003156 | Advanced Practice Registered Nurse | 2004-10-28 | 2019-10-01 - 2020-09-30 | ACTIVE |
| Street Address | 267 RTE 87 |
| City | COLUMBIA |
| State | CT |
| Zip Code | 06237 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Sima K Lessner | 15 Russmar Tr, Columbia, CT 06237 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Patricia A Kearns | 148 Old Willimantic Road, Columbia, CT 06237 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| John W Everett | 95 West St, Columbia, CT 06237 | Architect | 2020-08-01 ~ 2021-07-31 |
| Dona M Brodeur | 180 Pine St, Columbia, CT 06237 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Laura Bruckner | 181a Pine Street, Columbia, CT 06237 | Radiographer | 2020-05-01 ~ 2021-04-30 |
| Zachary Harbec | 14a Hennequin Rd., Columbia, CT 06237 | Backflow Prevention Device Tester | 2020-05-27 ~ 2023-03-31 |
| Jonathan Peschke | 5 Columbia Landing, Columbia, CT 06237 | Radiographer | 2020-08-01 ~ 2021-07-31 |
| Lynda A Everett | 534 Route 87, Columbia, CT 06237 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Donna C Hauschild | 37 Doubleday Rd, Columbia, CT 06237 | Licensed Practical Nurse | 2020-08-01 ~ 2021-07-31 |
| Theresa J Lagasse · Coughlin | 4 Randazzo Road, Columbia, CT 06237 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Find all Licenses in zip 06237 | |||
| City | COLUMBIA |
| Zip Code | 06237 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + COLUMBIA |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Arash Hadipour Niktarash | 25 Deforest St Apt C24, Seymour, CT 06483-2844 | Controlled Substance Registration for Practitioner | 2009-07-07 ~ 2011-02-28 |
| Jason Deforest Jones | 389 Summergate Dr, Winston Salem, NC 27103-5534 | Controlled Substance Registration for Practitioner | 2020-03-23 ~ 2021-02-28 |
| Kelly M Ferjentsik | 34 Little Fox Ln, Monroe, CT 06468-1607 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Kelly J Way | 34 B Springbrook Rd, Westerly, RI 02891 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Kelly Gullotta | Po Box 465, Brownsville, VT 05037-0465 | Controlled Substance Registration for Practitioner | 2020-04-09 ~ 2021-02-28 |
| Kelly M. Doran Md | New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Erin Kelly Walsh | 20 W End, Old Greenwich, CT 06870 | Controlled Substance Registration for Practitioner | 2020-06-25 ~ 2021-02-28 |
| Kelly K Bishop-bartolomei Md | Trumbull, CT 06611 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Janet A Lee | 29 James P Kelly Way, Middletown, NY 10940 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Carolyn A Kelly | 3 Mountain Dr, New Milford, CT 06776-4725 | 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).