JESSIE LARSON MD (Credential# 163128) 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.
JESSIE LARSON MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0021965. 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 13 Rebecca Lane, Killingworth, CT 06419. The current status is active.
| Licensee Name | JESSIE LARSON MD |
| Credential ID | 163128 |
| Credential Number | CSP.0021965 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
13 Rebecca Lane Killingworth CT 06419 |
| 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 |
|---|---|---|---|---|---|
| 551181 | 1.033582 | Physician/Surgeon | 1994-03-11 | 2019-08-01 - 2020-07-31 | ACTIVE |
| Street Address | 13 REBECCA LANE |
| City | KILLINGWORTH |
| State | CT |
| Zip Code | 06419 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Rajendra K Bobba | 39 Buell Hill Rd, Killingworth, CT 06419 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Deborah M Cabral | 61 Little Cty Rd, Killingworth, CT 06419 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Cheryl Dickson Toman | 16 Cedar Drive, Killingworth, CT 06419 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Nanci S Coleman | 9 Buell Hill Rd., Killingworth, CT 06419 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Sondra D Arbona | 21 Robin Ln, Killingworth, CT 06419 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Lisa R Barbour | 32 Boulder Trail, Killingworth, CT 06419 | Notary Public Appointment | 2020-10-01 ~ 2025-09-30 |
| Barbara K Irzyk | 12 Warwickshire Dr., Killingworth, CT 06419 | Speech and Language Pathologist | 2020-09-01 ~ 2021-08-31 |
| Diane Shauk Shuir | 184 Route 81 Bldg2, Killingworth, CT 06419 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-20 ~ 2022-05-31 |
| Yvonne Bradley | 42 Fawn Hill Road, Killingworth, CT 06419 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
| Staci L Petroskey | 140 Little City Road, Killingworth, CT 06419 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06419 | |||
| City | KILLINGWORTH |
| Zip Code | 06419 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + KILLINGWORTH |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jessie Gay | 1050 State St, New Haven, CT 06511-2762 | Controlled Substance Registration for Practitioner | 2019-08-13 ~ 2021-02-28 |
| Jessie Dewanjee | 4 Nadia S Way, Farmington, CT 06032-1991 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jessie Tijl Mangs | 298 Center St, Bristol, CT 06010-5021 | Controlled Substance Registration for Practitioner | 2019-01-23 ~ 2021-02-28 |
| Jessie E Brutus-darius Md | 2 Sierra Way, Danbury, CT 06810 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
| Jessie V Phillips Md | 300 Lucille Avenue, Elmont, NY 11003 | Controlled Substance Registration for Practitioner | 2011-04-07 ~ 2013-02-28 |
| Jessie R Stasulis Dmd | 11 Golf Road, West Hartford, CT 06117 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jessie C Long | 2028 Chapel Street, New Haven, CT 06515 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Jessie Marcoulier-gladu | 67 North Street, Granby, MA 01033 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jessie Ellen Reisig | 111 Park Street, New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Jessie M Moore Aprn | 1821 Little Meadow Rd, Guilford, CT 06437 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
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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).