Provider Demographics
NPI:1972068922
Name:HALLORAN, MIRANDA JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JEAN
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:JEAN
Other - Last Name:VAN STRATEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2985 TRIVERTON PIKE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711
Mailing Address - Country:US
Mailing Address - Phone:262-373-9840
Mailing Address - Fax:
Practice Address - Street 1:2985 TRIVERTON PIKE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711
Practice Address - Country:US
Practice Address - Phone:262-373-9840
Practice Address - Fax:888-251-2784
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WI11225-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical