=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255267563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STONE CIRCLE COLLABORATIVE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2026
-----------------------------------------------------
Last Update Date | 06/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 COURT ST
-----------------------------------------------------
City | MONTPELIER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-648-4874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 WITT PL APT 2
-----------------------------------------------------
City | MONTPELIER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-2828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-648-4874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MADELYN OWENS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 646-648-4874
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------