Healthcare Provider Details

I. General information

NPI: 1366132797
Provider Name (Legal Business Name): SIMONE-ELISE STERN HASSELMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIMONE HASSELMO

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GEORGE ST
NEW HAVEN CT
06511-6617
US

IV. Provider business mailing address

20 YORK ST
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-804-8459
  • Fax:
Mailing address:
  • Phone: 203-688-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number82534
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: