RICHARD P DIBALA MD (Credential# 153554) 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.
RICHARD P DIBALA MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0009844. 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 16 Jacobs Hill Rd, Mansfield Center, CT 06250-1650. The current status is active.
| Licensee Name | RICHARD P DIBALA MD |
| Credential ID | 153554 |
| Credential Number | CSP.0009844 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
16 Jacobs Hill Rd Mansfield Center CT 06250-1650 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-02 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 544157 | 1.022511 | Physician/Surgeon | 1980-12-03 | 2019-11-01 - 2020-10-31 | ACTIVE |
| Street Address | 16 JACOBS HILL RD |
| City | MANSFIELD CENTER |
| State | CT |
| Zip Code | 06250-1650 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Aaron Lassow | 70 Jacobs Hill Rd, Mansfield Center, CT 06250-1650 | Emergency Medical Responder | 2019-03-06 ~ 2021-12-31 |
| Sheri A Peabody | 28 Jacobs Hill Rd, Mansfield Center, CT 06250-1650 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Benjamin C Lassow | 70 Jacobs Hill Rd, Mansfield Center, CT 06250-1650 | Emergency Medical Technician | 2018-08-08 ~ 2021-07-01 |
| Laura J Lassow | 70 Jacobs Hill Rd, Mansfield Center, CT 06250-1650 | Licensed Clinical Social Worker | 2019-08-01 ~ 2020-07-31 |
| Michael B Lassow | 70 Jacobs Hill Rd, Mansfield Center, CT 06250-1650 | Real Estate Salesperson | 2011-03-01 ~ 2012-05-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Carissa A Zlotnick | 31 Jude Lane, Mansfield, CT 06250 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Sara Hollow Heumann | 103 Mansfield Hollow Road, Mansfield Center, CT 06250 | Esthetician | ~ |
| Mary Catherine D'amico | 156 Coventry Rd, Mansfield Center, CT 06250 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Petco 3728 | 86 Storrs Rd, Mansfield, CT 06250 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Christine D Njuki | 15 Crest Road, Mansfield Center, CT 06250 | Audiologist | 2020-07-01 ~ 2021-06-30 |
| David L. Simon Md | 2 Ledgebrook Drive, Mansfield Center, CT 06250 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Lisa G Orcutt | 5 Pequot Square, Mansfield Center, CT 06250 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Laurie J Smaglis | 28 Thornbush Rd, Mansfield, CT 06250 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Loni C Cohen | 23c Eastbrook Heights, Mansfield Center, CT 06250 | Notary Public Appointment | 2020-04-01 ~ 2025-03-31 |
| Joanne Frederick | 69 Circle Drive, Mansfield Center, CT 06250 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06250 | |||
| City | MANSFIELD CENTER |
| Zip Code | 06250 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + MANSFIELD CENTER |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Richard Young Pa | Belmont, VT 05730 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
| Richard Zhu | 20 York St Tmp 209, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Richard A Segool | 115 Elm St, Enfield, CT 06082 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Richard C Hsu Md | 7 Germantown Rd, Danbury, CT 06810 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Richard M Goldman | Po Box 518, Fairfield, CT 06824-0518 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Richard S Gottfried M.d. | 1 Theall Rd, Rye, NY 10580 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Richard L Yap Md | 151 Andrew Ave Apt 85, Naugatuck, CT 06770 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
| Richard N Smith | Po Box 388, Middlebury, CT 06762 | Controlled Substance Registration for Practitioner | 2016-06-16 ~ 2019-02-28 |
| Richard S Lee | 196 Crown St Apt 402, New Haven, CT 06510 | Controlled Substance Registration for Practitioner | 2004-10-25 ~ 2005-02-28 |
| Richard R Roccapriore Dpm | 739 Paddock Ave, Meriden, CT 06450 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
Please comment or provide details below to improve the information on RICHARD P DIBALA MD.
| 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).