DIANE GOODWIN PA-C
Controlled Substance Registration for Practitioner


Address: 5 Brookhills Rd, Branford, CT 06405-2815

DIANE GOODWIN PA-C (Credential# 477021) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2015. The license expiration date date is February 28, 2017. The license status is INACTIVE.

Business Overview

DIANE GOODWIN PA-C is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0041923. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2015. The expiration date is February 28, 2017. The business address is 5 Brookhills Rd, Branford, CT 06405-2815. The current status is inactive.

Basic Information

Licensee Name DIANE GOODWIN PA-C
Credential ID 477021
Credential Number CSP.0041923
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 5 Brookhills Rd
Branford
CT 06405-2815
Business Type INDIVIDUAL
Status INACTIVE
Issue Date 2007-07-20
Effective Date 2015-03-01
Expiration Date 2017-02-28
Refresh Date 2018-01-29

Other licenses

ID Credential Code Credential Type Issue Term Status
741954 23.000205 Physician Assistant 1993-10-15 2015-10-01 - 2016-09-30 INACTIVE

Office Location

Street Address 5 BROOKHILLS RD
City BRANFORD
State CT
Zip Code 06405-2815

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Competitor

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City BRANFORD
Zip Code 06405
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + BRANFORD

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Randolph A Goodwin Md 80 South Main St, Middletown, CT 06457 Controlled Substance Registration for Practitioner 2013-03-01 ~ 2015-02-28
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Dataset Information

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).

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