MEDICARE: KARLY ELLEN HAUSER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY13120	FL

General Provider Information

NPI Number	:	1255205522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLY ELLEN HAUSER PSYD

Provider Business Mailing Address
First Line	:	475 N FEDERAL HWY APT 2413
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 N FEDERAL HWY STE 202
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4609
Country	:	US
Telephone Number	:	800-457-4573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	01/27/2026

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