Provider Demographics
NPI:1972068922
Name:VAN STRATEN, MIRANDA JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JEAN
Last Name:VAN STRATEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 EASTWOOD DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5387
Mailing Address - Country:US
Mailing Address - Phone:608-255-9119
Mailing Address - Fax:
Practice Address - Street 1:2010 EASTWOOD DR STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5387
Practice Address - Country:US
Practice Address - Phone:608-255-9119
Practice Address - Fax:888-251-2784
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical