PARK CITY PRIMARY CARE CENTER
Psychiatric Outpatient Clinic


Address: 64 Black Rock Ave, Bridgeport, CT 06605-1200

PARK CITY PRIMARY CARE CENTER (Credential# 929152) is licensed (Psychiatric Outpatient Clinic) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2017. The license expiration date date is March 31, 2021. The license status is ACTIVE.

Business Overview

PARK CITY PRIMARY CARE CENTER is licensed with the Department of Consumer Protection of Connecticut. The credential number is #POCA.0000462. The credential type is psychiatric outpatient clinic. The effective date is April 1, 2017. The expiration date is March 31, 2021. The business address is 64 Black Rock Ave, Bridgeport, CT 06605-1200. The current status is active.

Basic Information

Licensee Name PARK CITY PRIMARY CARE CENTER
Business Name PARK CITY PRIMARY CARE CENTER
Doing Business As PARK CITY PRIMARY CARE CENTER
Credential ID 929152
Credential Number POCA.0000462
Credential Type Psychiatric Outpatient Clinic
Business Address 64 Black Rock Ave
Bridgeport
CT 06605-1200
Business Type BUSINESS
Status ACTIVE - CURRENT
Active 1
Issue Date 2009-06-19
Effective Date 2017-04-01
Expiration Date 2021-03-31
Refresh Date 2019-07-22

Other licenses

ID Credential Code Credential Type Issue Term Status
1231442 SA.0000475 Substance Abuse 2014-06-26 2018-04-01 - 2020-03-31 ACTIVE IN RENEWAL

Office Location

Street Address 64 BLACK ROCK AVE
City BRIDGEPORT
State CT
Zip Code 06605-1200

Licenses in the same location

Licensee Name Office Address Credential Effective / Expiration
Emely E. Gonzalez 64 Black Rock Ave, Bridgeport, CT 06605-1200 Community Health Worker 2020-03-19 ~ 2023-03-31
Park City Primary Care Center, Inc. 64 Black Rock Ave, Bridgeport, CT 06605-1200 Outpatient Clinic 2017-04-01 ~ 2021-03-31
Theresa Integral Dy Djama 64 Black Rock Ave, Bridgeport, CT 06605-1649 Controlled Substance Registration for Practitioner 2019-07-05 ~ 2021-02-28
Debra L Gerson 64 Black Rock Ave, Bridgeport, CT 06605-1200 Physician/surgeon 2018-03-01 ~ 2019-02-28

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Competitor

Search similar business entities

City BRIDGEPORT
Zip Code 06605
License Type Psychiatric Outpatient Clinic
License Type + County Psychiatric Outpatient Clinic + BRIDGEPORT

Similar businesses

Licensee Name Office Address Credential Effective / Expiration
Park City Primary Care Center, Inc. 64 Black Rock Ave, Bridgeport, CT 06605-1200 Outpatient Clinic 2017-04-01 ~ 2021-03-31
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Apt Foundation, Inc. Primary Care Services 425 Grant St, Bridgeport, CT 06610-3222 Outpatient Clinic 2015-01-01 ~ 2018-12-31
Apt Foundation, Inc. Primary Care Services New Haven, CT 06519 Outpatient Clinic ~
Health Care for The Homeless Clinic At South Park Inn 75 Main St, Hartford, CT 06106-1806 Psychiatric Outpatient Clinic 2018-01-01 ~ 2021-12-31
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Dataset Information

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).

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