STUART M FORMAN MD (Credential# 151103) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
STUART M FORMAN MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0010825. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 4 Squirrel Hill Lane, West Hartford, CT 06107. The current status is active.
| Licensee Name | STUART M FORMAN MD |
| Credential ID | 151103 |
| Credential Number | CSP.0010825 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
4 Squirrel Hill Lane West Hartford CT 06107 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-04-20 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2018-12-28 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 544662 | 1.023643 | Physician/Surgeon | 1982-06-18 | 2020-02-01 - 2021-01-31 | ACTIVE |
| Street Address | 4 SQUIRREL HILL LANE |
| City | WEST HARTFORD |
| State | CT |
| Zip Code | 06107 |
| 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 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + WEST HARTFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Rachel Forman | 15 York St, New Haven, CT 06510-3221 | Controlled Substance Registration for Practitioner | 2020-05-15 ~ 2021-02-28 |
| Amy L Forman | 4 Squirrel Hill La, West Hartford, CT 06107 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
| Leslie M Forman | 652 Mountain Laurel, Fairfield, CT 06430 | Controlled Substance Registration for Practitioner | 1995-10-25 ~ 1997-02-28 |
| Alexandra C Forman-chou Md | 46 Morse St, Hamden, CT 06517 | Controlled Substance Registration for Practitioner | 2005-03-01 ~ 2006-02-28 |
| Mary S Forman | 661 East Street, Litchfield, CT 06759-3721 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Joseph B Forman | 2 Church St South, New Haven, CT 06519 | Controlled Substance Registration for Practitioner | 1994-09-01 ~ 1996-09-01 |
| Rebecca Bella Forman | 1925 Eastchester Rd Apt 2e, Bronx, NY 10461-2187 | Controlled Substance Registration for Practitioner | 2019-06-05 ~ 2021-02-28 |
| Stuart A Kittay | 16 Hospital Ave Ste 302, Danbury, CT 06810-5994 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Stuart D Aaron Md | 215 Main St, Westport, CT 06880-3210 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Stuart G Lehrman Md | 6 Canterbury Ct, Danbury, CT 06811 | Controlled Substance Registration for Practitioner | 1993-02-10 ~ 1995-03-01 |
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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).