HAROLD MARK LICKEY MD
Physician/surgeon


Address: 101-5o Madeline Ave, Waterbury, CT 06708

HAROLD MARK LICKEY MD (Credential# 556165) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is March 20, 2001. The license expiration date date is March 31, 2002. The license status is INACTIVE.

Business Overview

HAROLD MARK LICKEY MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.038577. The credential type is physician/surgeon. The effective date is March 20, 2001. The expiration date is March 31, 2002. The business address is 101-5o Madeline Ave, Waterbury, CT 06708. The current status is inactive.

Basic Information

Licensee Name HAROLD MARK LICKEY MD
Credential ID 556165
Credential Number 1.038577
Credential Type Physician/Surgeon
Business Address 101-5o Madeline Ave
Waterbury
CT 06708
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 2000-04-24
Effective Date 2001-03-20
Expiration Date 2002-03-31
Refresh Date 2009-07-11

Other licenses

ID Credential Code Credential Type Issue Term Status
239590 CSP.0029694 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2001-03-01 - 2002-02-28 INACTIVE

Office Location

Street Address 101-5O MADELINE AVE
City WATERBURY
State CT
Zip Code 06708

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City WATERBURY
Zip Code 06708
License Type Physician/Surgeon
License Type + County Physician/Surgeon + WATERBURY

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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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