CITYBLOCK MEDICAL PRACTICE CT, P.C. (Credential# 2042607) is licensed (Outpatient Clinic) with Connecticut Department of Consumer Protection. The license effective date is May 6, 2020. The license expiration date date is March 31, 2022. The license status is ACTIVE.
CITYBLOCK MEDICAL PRACTICE CT, P.C. is licensed with the Department of Consumer Protection of Connecticut. The credential number is #OPC.0001079. The credential type is outpatient clinic. The effective date is May 6, 2020. The expiration date is March 31, 2022. The business address is 88 Valley St Fl 1, Bristol, CT 06010-4933. The current status is active.
| Licensee Name | CITYBLOCK MEDICAL PRACTICE CT, P.C. |
| Business Name | CITYBLOCK MEDICAL PRACTICE CT, P.C. |
| Doing Business As | CITYBLOCK MEDICAL PRACTICE CT, P.C. |
| Credential ID | 2042607 |
| Credential Number | OPC.0001079 |
| Credential Type | Outpatient Clinic |
| Business Address |
88 Valley St Fl 1 Bristol CT 06010-4933 |
| Business Type | CORPORATION |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2020-05-05 |
| Effective Date | 2020-05-06 |
| Expiration Date | 2022-03-31 |
| Refresh Date | 2020-05-06 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1989349 | OPC.0001069 | Outpatient Clinic | - | CLOSED |
| Business ID | 1293689 |
| Business Name | CITYBLOCK MEDICAL PRACTICE CT, P.C. |
| Registration Date | 2018-12-19 |
| State Citizenship | Domestic / CT |
| Business Status | Active |
| Agent Name | CT CORPORATION SYSTEM |
| Agent Business Address | 67 BURNSIDE AVE, EAST HARTFORD, CT 06108 |
| Street Address | 88 VALLEY ST FL 1 |
| City | BRISTOL |
| State | CT |
| Zip Code | 06010-4933 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Deborah M Dube · Adamaitis | 33 Peck Lane, Bristol, CT 06010 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Barbara M Williams | 45 Harrison Street, Bristol, CT 06010 | Notary Public Appointment | 2020-08-01 ~ 2025-07-31 |
| Le Bao Linh Nguyen | 229 Silo Rd, Bristol, CT 06010 | Nail Technician | ~ |
| Tara M Chipman | 38 Grove St, Bristol, CT 06010 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Jaclyn J Brandolini | 424 Emmett St, Bristol, CT 06010 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Hoa Le | 63 Seminary St, Bristol, CT 06010 | Nail Technician | ~ |
| Barbara E Trench | 25 Peacedale St, Bristol, CT 06010 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Tisha A Balfour | 379 West Street, Bristol, CT 06010 | Licensed Practical Nurse | 2020-08-01 ~ 2021-07-31 |
| Meredith Rose Martineau | 15 Bishop Street, Bristol, CT 06010 | Master's Level Social Worker - Temporary Permit | 2020-06-26 ~ 2020-09-06 |
| Jaime L Krueger | 130 Garfield Road, Bristol, CT 06010 | Notary Public Appointment | 2020-06-26 ~ 2025-06-30 |
| Find all Licenses in zip 06010 | |||
| City | BRISTOL |
| Zip Code | 06010 |
| License Type | Outpatient Clinic |
| License Type + County | Outpatient Clinic + BRISTOL |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Cityblock Health, Inc. | 34 Water St Ste 4c, Brooklyn, NY 11201-1303 | Securities - Exemptions | 2019-10-04 ~ |
| Institute of The Professional Practice, Inc. | 538 Preston Ave, Meriden, CT 06450-4851 | Psychiatric Outpatient Clinic | 2019-07-01 ~ 2023-06-30 |
| Outpatient Clinic | 205-209 Orange St, New Haven, CT 06511 | Psychiatric Outpatient Clinic | 2014-01-01 ~ 2017-12-31 |
| Outpatient Clinic | 205-209 Orange Street, New Haven, CT 06511 | Substance Abuse | 2016-01-01 ~ 2017-12-31 |
| Veteran's Outpatient Clinic | 287 West Street, Rocky Hill, CT 06067 | Outpatient Clinic | 2019-06-17 ~ 2022-03-31 |
| Modern Era Pediatric Practice | 3715 Main St Ste 403, Bridgeport, CT 06606-3611 | Wholesaler of Drugs, Cosmetics & Medical Devices | 2010-07-01 ~ 2011-06-30 |
| Mobile Medical Van | 120 Connecticut Ave, Norwalk, CT 06854-1525 | Outpatient Clinic | 2017-01-01 ~ 2020-12-31 |
| Best Practice Inc | Attn Lai Sun, Bridgeport, CT 06606 | Certified Public Accountant Firm Permit | 2005-01-01 ~ 2005-12-31 |
| Gilead Community Services, Inc Outpatient Clinic for Adults | 175 E Main St, Middletown, CT 06457-4460 | Psychiatric Outpatient Clinic | 2019-03-18 ~ 2022-12-31 |
| Polaris Outpatient Mental Health Clinic for Children & Families | 474 School St, East Hartford, CT 06108-1149 | Psychiatric Outpatient Clinic | 2014-10-01 ~ 2018-09-30 |
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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).