ANGELINA GOENAWAN (Credential# 1654267) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is June 20, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
ANGELINA GOENAWAN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0070801. The credential type is controlled substance registration for practitioner. The effective date is June 20, 2019. The expiration date is February 28, 2021. The business address is 130 Division St, Derby, CT 06418-1326. The current status is active.
| Licensee Name | ANGELINA GOENAWAN |
| Credential ID | 1654267 |
| Credential Number | CSP.0070801 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
130 Division St Derby CT 06418-1326 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-06-20 |
| Effective Date | 2019-06-20 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-06-20 |
| Street Address | 130 DIVISION ST |
| City | DERBY |
| State | CT |
| Zip Code | 06418-1326 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ricardo Concepcion Gomez | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Anwesh Poosala | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Da Young Ryu | 130 Division St, Derby, CT 06418 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Genevieve C Kela | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Inshiya Dawoodi | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Sovit Dahal | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Rosa Constantino | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Ivanshi Gondalia | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Angad Gill | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Douglas Palacios | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kathleen M Chaisson Md | 130 Division St # I, Derby, CT 06418-1326 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Turn The Tide Foundation Inc | 130 Division St Fl 2, Derby, CT 06418-1326 | Public Charity | 2017-12-01 ~ 2018-11-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Debra A Montini | 8 Academy Hill Ext, Derby, CT 06418 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Laura M Boanno | 131 Marshall La, Derby, CT 06418 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Danyun Chen | 49 Pershing Dr., Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Fan Geng | Shoprite Shopping Center, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Danni Xu | Shoprite Shopping Center49 Pershing Dr, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Yao Zhang | Shoprite Shopping Center 49 Pershing Dr, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Phillip N Burke | 3 Camptown St, Derby, CT 06418 | Emergency Medical Technician | 2017-06-07 ~ 2020-06-30 |
| Diane A Rosner | 229 Shagbark Drive, Derby, CT 06418 | Professional Counselor | 2020-08-01 ~ 2021-07-31 |
| Pamela C Lavelle | 194 Minerva St, Derby, CT 06418 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Grade A Market - Derby LLC | 49 Pershing Dr, Derby, CT 06418 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06418 | |||
| City | DERBY |
| Zip Code | 06418 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + DERBY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Angelina M Angeli | 613 6th Ridge Rd, Wallingford, CT 06492-2026 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Angelina L. Trujillo | 720 East Grant Street, Spearfish, SD 57783 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Angelina N Chambers | 4001 Fannin St Apt 4318, Houston, TX 77004-4080 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Angelina Gavel-rukha | 63 Regency Park Dr, Agawam, MA 01001-2252 | Controlled Substance Registration for Practitioner | 2019-07-15 ~ 2021-02-28 |
| Steven Kassels Md · Community Substance Abuse Center | Comm. Physicians PC/125 North Elm Street, Westfield, MA 01085 | Controlled Substance Registration for Practitioner | 2018-06-15 ~ 2019-02-28 |
| Angel Goenawan | 130 Division St, Derby, CT 06418 | Resident Physician | 2019-07-01 ~ 2022-06-30 |
| Angelina's | 1092 Post Rd E, Westport, CT 06880-5345 | Bakery | 2019-10-16 ~ 2020-06-30 |
| Angelina Fragolino | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2011-09-07 ~ 2014-09-06 |
| Shu-i Lin | CT | Controlled Substance Registration for Practitioner | 2017-06-12 ~ 2019-02-28 |
| Qi Che Md | Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2006-03-01 ~ 2007-02-28 |
Please comment or provide details below to improve the information on ANGELINA GOENAWAN.
| 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).