MARY BETH E VAN SICLEN (Credential# 1232807) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is April 4, 2018. The license expiration date date is February 28, 2019. The license status is LAPSED.
MARY BETH E VAN SICLEN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0057893. The credential type is controlled substance registration for practitioner. The effective date is April 4, 2018. The expiration date is February 28, 2019. The business address is 180 Barbara Rd, Middletown, CT 06457-2404. The current status is lapsed.
| Licensee Name | MARY BETH E VAN SICLEN |
| Credential ID | 1232807 |
| Credential Number | CSP.0057893 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
180 Barbara Rd Middletown CT 06457-2404 |
| Business Type | INDIVIDUAL |
| Status | LAPSED |
| Active | 1 |
| Issue Date | 2014-07-29 |
| Effective Date | 2018-04-04 |
| Expiration Date | 2019-02-28 |
| Refresh Date | 2019-03-06 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1488248 | 1.057665-RES | Resident Physician | 2014-06-23 | 2014-06-23 - 2018-09-16 | INACTIVE |
| Street Address | 180 BARBARA RD |
| City | MIDDLETOWN |
| State | CT |
| Zip Code | 06457-2404 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mary Beth Van Siclen | 180 Barbara Rd, Middletown, CT 06457-2404 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elizabeth M Mailhot | 177 Timber Ridge Rd, Middletown, CT 06457 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Rebecca S Fennessy | 22 Keefe Ln, Middletown, CT 06457 | Licensed Clinical Social Worker | 2020-07-01 ~ 2021-06-30 |
| Eloise M Gagnon | 538 Bow Lane, Middletown, CT 06457 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Salvatore Dimauro | 245 Dekoven Dr, Middletown, CT 06457 | Public Weigher | 2020-07-01 ~ 2021-06-30 |
| Frank L Wright | 261 Spencer Dr, Middletown, CT 06457 | Barber | 2020-08-01 ~ 2022-07-31 |
| Gino A Cardella | 50 Sonoma Lane, Middletown, CT 06457 | Real Estate Salesperson | ~ |
| Shannon Lee Mcquillan | 5 Forest Glen Circle, Middletown, CT 06457 | Registered Nurse | 2020-06-26 ~ 2020-09-30 |
| Lori Dimauro · Carta | 244 Chamberlain Hill Road, Middletown, CT 06457 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Gail A Corrow | 85 Dora Dr, Middletown, CT 06457 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Mariter V Perez | 8 Moss Glen, Middletown, CT 06457 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06457 | |||
| City | MIDDLETOWN |
| Zip Code | 06457 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + MIDDLETOWN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mary Beth Van Siclen | 180 Barbara Rd, Middletown, CT 06457-2404 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Mary Beth A Wetzelberger | 119 Lafayette Ave, Westwood, NJ 07675-5252 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Mary Beth Downer Pa-c | 40 Washington Mews, Port Chester, NY 10573 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
| Beth T Fracasso | 305 Old Ln Rd, Cheshire, CT 06410 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Beth A Dean Pa-c | 67 Hildurcrest Dr, Simsbury, CT 06070-2757 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Beth A Ditkoff Md | 7 Park Rd, Scarsdale, NY 10583 | Controlled Substance Registration for Practitioner | 2007-03-01 ~ 2008-02-29 |
| Beth W Rackow Md | Cwrc, New York, NY 10019 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Beth G Liebmann Pa | 8 Holly Ln, Rye Brook, NY 10573 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
| Beth D Grunschel | 32 Trumbull St, New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Beth Villodas | 196 East St, Stafford, CT 06076 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on MARY BETH E VAN SICLEN.
| 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).