Provider Demographics
NPI:1386800787
Name:COLON, SOR ORTIZ (MA, PH D, LPC,)
Entity type:Individual
Prefix:DR
First Name:SOR
Middle Name:ORTIZ
Last Name:COLON
Suffix:
Gender:F
Credentials:MA, PH D, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1121
Mailing Address - Country:US
Mailing Address - Phone:787-942-4066
Mailing Address - Fax:787-914-5883
Practice Address - Street 1:CARRETERA 198 K21 H9 BO. QUEBRADADA ARENA
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-942-4066
Practice Address - Fax:787-914-5883
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101YA0400X, 101YP1600X, 103TA0400X, 103TC1900X, 103TF0000X
PR2321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily