HARTFORD DISPENSARY-BRISTOL CLINIC (Credential# 930011) is licensed (Psychiatric Outpatient Clinic) with Connecticut Department of Consumer Protection. The license effective date is January 1, 2020. The license expiration date date is December 31, 2023. The license status is ACTIVE.
HARTFORD DISPENSARY-BRISTOL CLINIC is licensed with the Department of Consumer Protection of Connecticut. The credential number is #POCA.0000331. The credential type is psychiatric outpatient clinic. The effective date is January 1, 2020. The expiration date is December 31, 2023. The business address is 1098 Farmington Ave, Bristol, CT 06010-4705. The current status is active.
| Licensee Name | HARTFORD DISPENSARY-BRISTOL CLINIC |
| Business Name | HARTFORD DISPENSARY-BRISTOL CLINIC |
| Doing Business As | HARTFORD DISPENSARY-BRISTOL CLINIC |
| Credential ID | 930011 |
| Credential Number | POCA.0000331 |
| Credential Type | Psychiatric Outpatient Clinic |
| Business Address |
1098 Farmington Ave Bristol CT 06010-4705 |
| Business Type | BUSINESS |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2008-01-01 |
| Effective Date | 2020-01-01 |
| Expiration Date | 2023-12-31 |
| Refresh Date | 2019-12-04 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 930305 | SA.0000258 | Substance Abuse | 2010-01-01 | 2020-01-01 - 2021-12-31 | ACTIVE |
| 331671 | CSP.0033303 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2003-03-13 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 1098 FARMINGTON AVE |
| City | BRISTOL |
| State | CT |
| Zip Code | 06010-4705 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Hartford Dispensary-bristol Clinic | 1098 Farmington Ave, Bristol, CT 06010 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Deborah M Dube · Adamaitis | 33 Peck Lane, Bristol, CT 06010 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Barbara M Williams | 45 Harrison Street, Bristol, CT 06010 | Notary Public Appointment | 2020-08-01 ~ 2025-07-31 |
| Le Bao Linh Nguyen | 229 Silo Rd, Bristol, CT 06010 | Nail Technician | ~ |
| Tara M Chipman | 38 Grove St, Bristol, CT 06010 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Jaclyn J Brandolini | 424 Emmett St, Bristol, CT 06010 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Hoa Le | 63 Seminary St, Bristol, CT 06010 | Nail Technician | ~ |
| Barbara E Trench | 25 Peacedale St, Bristol, CT 06010 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Tisha A Balfour | 379 West Street, Bristol, CT 06010 | Licensed Practical Nurse | 2020-08-01 ~ 2021-07-31 |
| Meredith Rose Martineau | 15 Bishop Street, Bristol, CT 06010 | Master's Level Social Worker - Temporary Permit | 2020-06-26 ~ 2020-09-06 |
| Jaime L Krueger | 130 Garfield Road, Bristol, CT 06010 | Notary Public Appointment | 2020-06-26 ~ 2025-06-30 |
| Find all Licenses in zip 06010 | |||
| City | BRISTOL |
| Zip Code | 06010 |
| License Type | Psychiatric Outpatient Clinic |
| License Type + County | Psychiatric Outpatient Clinic + BRISTOL |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Hartford Dispensary-willimantic Clinic | 54-56 Boston Post Rd, Willimantic, CT 06226-2920 | Psychiatric Outpatient Clinic | 2017-04-01 ~ 2021-03-31 |
| Hartford Dispensary - Torrington Clinic | 140 Commercial Blvd, Torrington, CT 06790-3098 | Psychiatric Outpatient Clinic | 2018-07-01 ~ 2022-06-30 |
| Hartford Dispensary - Doctor's Clinic | 345 Main St, Hartford, CT 06106-1824 | Psychiatric Outpatient Clinic | 2017-04-01 ~ 2021-03-31 |
| Hartford Dispensary - Norwich Clinic | 772 W Thames St, Norwich, CT 06360-7070 | Psychiatric Outpatient Clinic | 2017-04-01 ~ 2021-03-31 |
| Hartford Dispensary-manchester Clinic | 335 Broad St, Manchester, CT 06040-4036 | Psychiatric Outpatient Clinic | 2020-04-01 ~ 2023-03-31 |
| Hartford Dispensary-new London Clinic | 931 Bank St, New London, CT 06320-2702 | Psychiatric Outpatient Clinic | 2017-04-01 ~ 2021-03-31 |
| Hartford Dispensary-norwich Clinic | 772 W Thames St, Norwich, CT 06360-7070 | Psychiatric Outpatient Clinic | 2020-01-22 ~ 2022-12-31 |
| Hartford Dispensary - New Britain Clinic | 70 Whiting St, New Britain, CT 06051-3183 | Psychiatric Outpatient Clinic | 2017-04-01 ~ 2021-03-31 |
| The Hartford Dispensary · Hartford Dispensary Henderson Johnson Clinic-primary Clinic | 12-14 Weston St, Hartford, CT 06120-1504 | Outpatient Clinic | 2019-01-01 ~ 2021-12-31 |
| Hartford Dispensary-henderson/johnson Clinic | 12-14 Weston St, Hartford, CT 06120 | Psychiatric Outpatient Clinic | 2017-04-01 ~ 2021-03-31 |
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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).