AMANDA MARIE KINGSTON (Credential# 1401134) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is February 1, 2019. The license expiration date date is January 31, 2020. The license status is ACTIVE.
AMANDA MARIE KINGSTON is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.056214. The credential type is physician/surgeon. The effective date is February 1, 2019. The expiration date is January 31, 2020. The business address is 34 Park St, New Haven, CT 06519-1109. The current status is active.
| Licensee Name | AMANDA MARIE KINGSTON |
| Credential ID | 1401134 |
| Credential Number | 1.056214 |
| Credential Type | Physician/Surgeon |
| Business Address |
34 Park St New Haven CT 06519-1109 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2017-02-27 |
| Effective Date | 2019-02-01 |
| Expiration Date | 2020-01-31 |
| Refresh Date | 2019-01-08 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1417520 | CSP.0065190 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2017-04-12 | 2017-04-12 - 2019-02-28 | LAPSED |
| Street Address | 34 PARK ST |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06519-1109 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Alexander R N Westphal Md | 34 Park St, New Haven, CT 06519-1109 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Brittany Quagan | 34 Park St, New Haven, CT 06519 | Professional Counselor | 2020-07-01 ~ 2021-06-30 |
| Nhut Giuc Tran | 34 Park St, New Haven, CT 06519-1109 | Resident Physician | 2019-12-23 ~ 2021-06-30 |
| Jeanne Steiner Do | 34 Park St, New Haven, CT 06519 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Mark D Simoniello | 34 Park St, New Haven, CT 06519-1109 | Licensed Clinical Social Worker | 2020-05-01 ~ 2021-04-30 |
| Evan Michael Vitiello | 34 Park St, New Haven, CT 06519-1109 | Controlled Substance Registration for Practitioner | 2020-06-10 ~ 2021-02-28 |
| Hassan Naqvi | 34 Park St, New Haven, CT 06519-1109 | Controlled Substance Registration for Practitioner | 2019-06-11 ~ 2021-02-28 |
| Carmen Gabrielle Parker | 34 Park St, New Haven, CT 06519-1109 | Controlled Substance Registration for Practitioner | 2019-07-01 ~ 2021-02-28 |
| Ct Mental Health Center · Robert Cole | 34 Park St, New Haven, CT 06519 | Controlled Substance Registration for Hospitals | 2019-03-01 ~ 2021-02-28 |
| Mohini Ranganathan | 34 Park St, New Haven, CT 06511-5474 | Controlled Substance Laboratory | 2020-02-01 ~ 2021-01-31 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ayana M Jordan | 34 Park St # W203, New Haven, CT 06519-1109 | Resident Physician | 2015-07-02 ~ 2021-06-30 |
| Merrill Abraham Mathew | 34 Park St Rm 153, New Haven, CT 06519-1109 | Resident Physician | 2019-09-26 ~ 2021-06-30 |
| Jane R Taylor · Yale University School of Medicine | 34 Park St Rm S309, New Haven, CT 06519-1109 | Controlled Substance Laboratory | 2020-02-01 ~ 2021-01-31 |
| Gerard Sanacora | 34 Park St Rm W306, New Haven, CT 06519-1109 | Controlled Substance Laboratory | 2019-12-23 ~ 2021-01-31 |
| Connecticut Mental Health Foundation Inc. | 34 Park St Ste 144, New Haven, CT 06519-1109 | Public Charity | 2019-12-01 ~ 2020-11-30 |
| Richard S Schottenfeld Md | 34 Park St Rm S205, New Haven, CT 06519-1109 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Cornell Scott-hill Health Center At Cmhc | 34 Park St # 261, New Haven, CT 06519-1109 | Outpatient Clinic | 2017-01-01 ~ 2020-12-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Vinod H Srihari Md | 34 Park St Cmhc, New Haven, CT 06519 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Monica Brito Salinas | 111 Kimberly Ave., New Haven, CT 06519 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2022-02-28 |
| Walter Mathis | 34 Park St., New Haven, CT 06519 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Kimberly Pizza · Emmanuel Zorgias | 34 Kimberly Ave, New Haven, CT 06519 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Slawomir Piascik | 51 Longhini Lane, New Haven, CT 06519 | Asbestos Abatement Supervisor | 2020-08-01 ~ 2021-07-31 |
| Margaret T Boron | 428 Columbus Ave, New Haven, CT 06519 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Laura Ann Dicola | Connecticut Mental Health Center Law & Psychiatry, New Haven, CT 06519 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Elizabeth Parson | 689 Congress Ave, New Haven, CT 06519 | Medication Administration Certification | 2020-08-05 ~ 2022-08-04 |
| Alejandra Lopez Cervantes | 10 Hedge St, New Haven, CT 06519 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-20 ~ 2021-08-31 |
| Deicy Alexandra Urena Dagua | 267 Howard Ave, New Haven, CT 06519 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-20 ~ 2021-10-31 |
| Find all Licenses in zip 06519 | |||
| City | NEW HAVEN |
| Zip Code | 06519 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + NEW HAVEN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Feras Elhajj Md | 500 Washington Ave #10-i, Kingston, NY 12401 | Physician/surgeon | 2002-06-07 ~ 2003-06-30 |
| Charles Kutler | 360 Washington Ave, Kingston, NY 12401-3702 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
| Marc J Teitelbaum | P.o.box 1863, Kingston, RI 02881 | Physician/surgeon | 2000-03-30 ~ 2000-09-30 |
| Frank A Sievert | 110 Fairview Ave, Kingston, NY 12401 | Physician/surgeon | 2003-08-11 ~ 2004-01-31 |
| Maja Ilic | 24 Kingston Rd, Scarsdale, NY 10583-1150 | Physician/surgeon | 2012-09-24 ~ 2013-03-31 |
| Konrad K-y Chan | 700 Sir John A Mac, Kingston On K7m 1a4 | Physician/surgeon | ~ 1999-06-30 |
| Daniel D Mott | 5 Gore St, Kingston, K7L 0A1 | Physician/surgeon | 2007-12-04 ~ 2009-01-31 |
| Amber Noelle Mitchell | 76 Hillcrest Avenue, Kingston, NY 12401 | Physician/surgeon | ~ |
| Emilie T Zipagan-azocar | 15 Kingston Ter, Waltham, MA 02451-2343 | Physician/surgeon | 2019-12-01 ~ 2020-11-30 |
| Stephen E Depasquale | 43 Petal Lane, S Kingston, RI 02879 | Physician/surgeon | 2000-05-23 ~ 2001-06-30 |
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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).