MARYBETH A MOORE (Credential# 1052451) is licensed (Physician Assistant) 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.
MARYBETH A MOORE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.002729. The credential type is physician assistant. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 60 Ridgewood Rd, West Hartford, CT 06107-2925. The current status is active.
| Licensee Name | MARYBETH A MOORE |
| Credential ID | 1052451 |
| Credential Number | 23.002729 |
| Credential Type | Physician Assistant |
| Business Address |
60 Ridgewood Rd West Hartford CT 06107-2925 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2012-02-27 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-04-24 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1055242 | CSP.0052090 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2012-03-09 | 2019-04-29 - 2021-02-28 | ACTIVE |
| Street Address | 60 RIDGEWOOD RD |
| City | WEST HARTFORD |
| State | CT |
| Zip Code | 06107-2925 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Anthony Reynolds | 88 Ridgewood Rd, West Hartford, CT 06107-2925 | Wholesaler Salesman | 2009-02-20 ~ 2013-01-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Rebecca L Stansfield | 73 Tunxis Road, West Hartford, CT 06107 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Kumari Joshi | 44 Bentwood Rd, West Hartford, CT 06107 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Laurie C Caines Md | 205 Stoner Drive, West Hartford, CT 06107 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Nicole K. Edlund | 11 Greenacres Avenue, West Hartford, CT 06107 | Master's Level Social Worker - Temporary Permit | ~ |
| Andrea M Yuliano | 39 Mountain Terrace Road, West Hartford, CT 06107 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Elizabeth M Ineson | 4 Linwold Dr, West Htfd, CT 06107 | Architect | 2020-08-01 ~ 2021-07-31 |
| Sarah G Potter | 19 Westland Ave, West Hartford, CT 06107 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Jessica C Abreu | 14 Deepwood Lane, West Hartford, CT 06107 | Real Estate Salesperson | 2020-06-18 ~ 2021-05-31 |
| William C Richter | 67 Hillsboro Drive, West Hartford, CT 06107 | Architect | 2020-08-01 ~ 2021-07-31 |
| Teresa M Stanton | 25 Common Dr., West Hartford, CT 06107 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06107 | |||
| City | WEST HARTFORD |
| Zip Code | 06107 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + WEST HARTFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Marybeth S Markham | 700 Russell Road, Westfield, MA 01085 | Physician Assistant | 2000-06-06 ~ 2000-08-31 |
| Marybeth Carletta Pa | 24113 Tjown Walk Dr, Hamden, CT 06518 | Physician Assistant | 1997-05-27 ~ 1998-05-31 |
| Sarah Moore | 1345 Rxr Plz, Uniondale, NY 11556-1301 | Physician Assistant | 2017-05-01 ~ 2018-04-30 |
| Matthew J Moore | 55 Langdon Ct, Berlin, CT 06037-1316 | Physician Assistant | 2019-02-01 ~ 2020-01-31 |
| Jenna Rae Miller | 298 Moore Street, Chicopee, MA 01013 | Physician Assistant | 2020-02-19 ~ 2021-02-28 |
| Heather K Moore Pa | 5 Farmington Meadow Dr, Farmington, CT 06032 | Physician Assistant | 2004-11-05 ~ 2005-11-30 |
| Marybeth Hafele | 87 Plaskon Dr, Shelton, CT 06484-4325 | Physical Therapist Assistant | 2020-01-01 ~ 2020-12-31 |
| Marybeth M Brown | 8 Perryridge Rd, Greenwich, CT 06830 | Real Estate Salesperson | ~ |
| Physician Assistant Foundation of The American Academy of Physician Assistants | 2318 Mill Rd Ste 1300, Alexandria, VA 22314-6868 | Public Charity | 2019-12-01 ~ 2020-11-30 |
| Cynthia M Moore | 80 Seymour St., Hartford, CT 06102 | Physical Therapist Assistant | ~ 2006-11-01 |
Please comment or provide details below to improve the information on MARYBETH A MOORE.
| 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).