MEDICARE: DR. SOR ORTIZ COLON MA, PH. D., LPC,

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	101YP1600X	Pastoral Counselor	PR-22-0013	PR
2	101YM0800X	Mental Health Counselor	TPMC3929	FL
3	103TA0400X	Addiction (Substance Use Disorder) Psychologist		PR
4	103TC1900X	Counseling Psychologist		PR
5	103TF0000X	Family Psychologist		PR
6	101YA0400X	Addiction (Substance Use Disorder) Counselor		PR
7	101YP2500X	Professional Counselor	2321	PR

General Provider Information

NPI Number	:	1386800787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOR ORTIZ COLON MA, PH. D., LPC,

Provider Business Mailing Address
First Line	:	1855 WELLS RD STE 1
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-6766
Country	:	US
Telephone Number	:	904-523-1287
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 WELLS RD STE 1
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-6766
Country	:	US
Telephone Number	:	904-523-1287
Fax Number	:

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	02/17/2026

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