RACHEL FORMAN (Credential# 2045226) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is May 15, 2020. The license expiration date date is February 28, 2021. The license status is ACTIVE.
RACHEL FORMAN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0074044. The credential type is controlled substance registration for practitioner. The effective date is May 15, 2020. The expiration date is February 28, 2021. The business address is 15 York St, New Haven, CT 06510-3221. The current status is active.
| Licensee Name | RACHEL FORMAN |
| Credential ID | 2045226 |
| Credential Number | CSP.0074044 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
15 York St New Haven CT 06510-3221 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2020-05-15 |
| Effective Date | 2020-05-15 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-05-20 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 2007089 | 1.065600 | Physician/Surgeon | 2020-05-15 | 2020-05-15 - 2020-08-31 | ACTIVE |
| Street Address | 15 YORK ST |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06510-3221 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mark Spencer Godfrey | 15 York St, New Haven, CT 06510-3221 | Physician/surgeon | 2020-06-02 ~ 2021-09-30 |
| Sarthak Virmani | 15 York St, New Haven, CT 06510-3221 | Resident Physician | 2017-07-01 ~ 2021-06-30 |
| Peter M. Glazer | 15 York St, New Haven, CT 06510-3221 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Kyle T Bramley | 15 York St, New Haven, CT 06510 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Shilpa M Hattangadi | 15 York St, New Haven, CT 06520-8064 | Controlled Substance Registration for Practitioner | 2019-03-07 ~ 2021-02-28 |
| Adam S Jasne | 15 York St, New Haven, CT 06510-3221 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Faiza Yasin | 15 York St, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Meena S Moran Md | 15 York St, New Haven, CT 06520 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Matthew H Dodd | 15 York St, New Haven, CT 06520 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Aline Herlopian | 15 York St, New Haven, CT 06510 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Sharma Kattel | 29 York St, New Haven, CT 06510-3221 | Controlled Substance Registration for Practitioner | ~ |
| Asmita Paudyal-koirala | 25 York St Lmp 1072, New Haven, CT 06510-3221 | Resident Physician | 2018-07-01 ~ 2021-06-30 |
| Amir Soheil Tolebeyan | 15 York St # LLCi710, New Haven, CT 06510-3221 | Resident Physician | 2019-07-10 ~ 2021-06-30 |
| Bertrand Paul Tseng | 15 York St LLCi 920b, New Haven, CT 06510-3221 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Albert J Sinusas · Yale University Oehs | 15 York St # Lci-111b, New Haven, CT 06510-3221 | Controlled Substance Laboratory | 2020-02-01 ~ 2021-01-31 |
| Peggy Myung | 15 York St Hrt 618c, New Haven, CT 06510-3221 | Controlled Substance Laboratory | 2020-02-01 ~ 2021-01-31 |
| Zhong Yun · Yale University School of Medicine | 15 York St Hrt 308, New Haven, CT 06510-3221 | Controlled Substance Laboratory | 2020-02-01 ~ 2021-01-31 |
| Monika S Laurans Pa | 15 York St LLCi 920, New Haven, CT 06510-3221 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| James J Farrell | 15 York St Lmp 1080, New Haven, CT 06510-3221 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Romina Shirka | 15 York St LLCi 714, New Haven, CT 06510-3221 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Find all Licenses in zip 06510-3221 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Gary P Bernardi Jr | Yale New Haven Hospital, New Haven, CT 06510 | Advanced Practice Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Katherine G Kennedy | 65 Trumbull St, New Haven, CT 06510 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Molly Elizabeth Mcadow | 333 Cedar Street, New Haven, CT 06510 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Brady Dunkle | 58 Vernon Street, New Haven, CT 06510 | Registered Nurse | ~ |
| Karin Ann Price | 20 York St, New Haven, Ct 06510, New Haven, CT 06510 | Registered Nurse - Temporary | 2020-06-25 ~ 2020-10-23 |
| G C S Constuction LLC | 142 Temple Street, New Haven, CT 06510 | Major Contractor | 2020-07-01 ~ 2021-06-30 |
| Paul L Mccarthy Md · Yale School of Medicine | Dept of Pediatrics, New Haven, CT 06510 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Lauren E Cohn Md | Yale New-haven Hospital, New Haven, CT 06510 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Bong Francois | 900 Chapel St Apt 901, New Haven, CT 06510 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Pelli Clarke Pelli Architects Inc. | 1056 Chapel St, New Haven, CT 06510 | Architecture Corporation | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06510 | |||
| City | NEW HAVEN |
| Zip Code | 06510 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + NEW HAVEN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Joseph B Forman | 2 Church St South, New Haven, CT 06519 | Controlled Substance Registration for Practitioner | 1994-09-01 ~ 1996-09-01 |
| 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 |
| Amy L Forman | 4 Squirrel Hill La, West Hartford, CT 06107 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
| Mary S Forman | 661 East Street, Litchfield, CT 06759-3721 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Rebecca Bella Forman | 1925 Eastchester Rd Apt 2e, Bronx, NY 10461-2187 | Controlled Substance Registration for Practitioner | 2019-06-05 ~ 2021-02-28 |
| Stuart M Forman Md | 4 Squirrel Hill Lane, West Hartford, CT 06107 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Rachel Lin | 6b Orchard St, Cos Cob, CT 06807-2407 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Rachel Ng | 198 Edwards St Apt 4, New Haven, CT 06511-3702 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Rachel M Kahn Dds | 109 Federal Rd, Brookfield, CT 06804 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
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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).