Healthcare Provider Details

I. General information

NPI: 1386800787
Provider Name (Legal Business Name): SOR ORTIZ COLON MA, PH. D., LPC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 198 K21 H9 BO. QUEBRADADA ARENA
LAS PIEDRAS PR
00771
US

IV. Provider business mailing address

PO BOX 1121
LAS PIEDRAS PR
00771-1121
US

V. Phone/Fax

Practice location:
  • Phone: 787-942-4066
  • Fax: 787-914-5883
Mailing address:
  • Phone: 787-942-4066
  • Fax: 787-914-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2321
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: