Provider Demographics
NPI:1861846495
Name:SAPORITO, FRED J (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:J
Last Name:SAPORITO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:FRED
Other - Middle Name:J
Other - Last Name:SAPORITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:205 SE DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1333
Mailing Address - Country:US
Mailing Address - Phone:541-388-9904
Mailing Address - Fax:541-388-4997
Practice Address - Street 1:205 SE DAVIS AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1333
Practice Address - Country:US
Practice Address - Phone:541-388-9904
Practice Address - Fax:541-388-4997
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006OtherOR. BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS