KEITH BRADLEY (Credential# 544648) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.
KEITH BRADLEY is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.023622. The credential type is physician/surgeon. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 66 Lilalyn Drive, Fairfield, CT 06825. The current status is active.
| Licensee Name | KEITH BRADLEY |
| Credential ID | 544648 |
| Credential Number | 1.023622 |
| Credential Type | Physician/Surgeon |
| Business Address |
66 Lilalyn Drive Fairfield CT 06825 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1982-06-09 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-02-18 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 152417 | CSP.0010847 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2004-08-09 | 2004-08-09 - 2005-02-28 | INACTIVE |
| Street Address | 66 LILALYN DRIVE |
| City | FAIRFIELD |
| State | CT |
| Zip Code | 06825 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Norean Lennon-bradley | 66 Lilalyn Drive, Fairfield, CT 06825 | Licensed Clinical Social Worker | 2020-08-01 ~ 2021-07-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Alexander M Testani | 77 Winoca Rd, Fairfield, CT 06825 | Emergency Medical Technician | 2020-06-26 ~ 2022-03-31 |
| Salome Cleopatra Nail | 2399 Black Rock Turnpike, Fairfield, CT 06825 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Angela M Carmona | 198 Castle Ave, Fairfield, CT 06825 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Maria D Coutinho | 131 Roseville Street, Fairfield, CT 06825 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Jie Che | 1519 Black Rock Tpke, Fairfield, CT 06825 | Esthetician | ~ |
| Eva I Chiamulera | 86 Brookfield Avenue, Fairfield, CT 06825 | Landscape Architect | 2020-08-01 ~ 2021-07-31 |
| Suzanne P Taluy | 558 Villa Ave, Fairfield, CT 06825 | Licensed Clinical Social Worker | 2020-07-01 ~ 2021-06-30 |
| Benjamin Allan Gott | 262 Euclid Avenue, Fairfield, CT 06825 | Notary Public Appointment | 2020-06-01 ~ 2025-05-31 |
| Charles J Applebaum | 841 Stratfield Rd, Fairfield, CT 06825 | Dentist | 2020-07-01 ~ 2021-06-30 |
| Jeri Kriskey | 1179 Merritt Street, Fairfield, CT 06825 | Marital and Family Therapist Associate | 2020-06-24 ~ 2022-06-24 |
| Find all Licenses in zip 06825 | |||
| City | FAIRFIELD |
| Zip Code | 06825 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + FAIRFIELD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Keith C Boldon Md | Keith Boldon Md, Cheshire, CT 06410 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Bradley Han Lee | 535 E 70th St, New York, NY 10021 | Physician/surgeon | ~ |
| Bradley H Staehle Md | Po Box 53, Weatogue, CT 06089 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Keith A Cauley | 33 Fairview Dr, Farmington, CT 06032-2516 | Physician/surgeon | 2020-01-24 ~ 2020-08-31 |
| Keith A Hernandez Md | 193 River Rd, Madison, CT 06443 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Keith Ray Hodge Md | 95 Dover Rd, W Hartford, CT 06119 | Physician/surgeon | 2001-03-12 ~ 2002-03-31 |
| Keith J Champney | 17 Ewell Ave, Lexington, MA 02421 | Physician/surgeon | 1999-10-14 ~ 2000-08-31 |
| Keith A Vom Eigen | 37 Hobson Ave, Windsor, CT 06095 | Physician/surgeon | 2020-01-01 ~ 2020-12-31 |
| Keith M Spellman | Po Box 320757, Los Gatos, CA 95032-0112 | Physician/surgeon | 2018-09-01 ~ 2019-08-31 |
| Keith Gallagher | 11 Bishop St, New Haven, CT 06511-3931 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Please comment or provide details below to improve the information on KEITH BRADLEY.
| 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).