MEDICARE: ANCORA PSYCHOLOGICAL INSTITUTE LLC

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

General Provider Information

NPI Number	:	1831040138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCORA PSYCHOLOGICAL INSTITUTE LLC

Provider Business Mailing Address
First Line	:	1725 MAIN ST STE 223
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 MAIN ST STE 223
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3671
Country	:	US
Telephone Number	:	754-778-5705
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KELLY SANTANDREA
Credential	:	PSY.D ABPP
Telephone Number	:	754-778-5705

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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