Healthcare Provider Details

I. General information

NPI: 1255267563
Provider Name (Legal Business Name): STONE CIRCLE COLLABORATIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 COURT ST
MONTPELIER VT
05602-2813
US

IV. Provider business mailing address

4 WITT PL APT 2
MONTPELIER VT
05602-2828
US

V. Phone/Fax

Practice location:
  • Phone: 646-648-4874
  • Fax:
Mailing address:
  • Phone: 646-648-4874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MADELYN OWENS
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 646-648-4874