Matthew David Domico, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149013431 Issued in IL

Practice address

712 E War Memorial Dr
Peoria, IL 61616-7548

Phone

(815) 701-6317

NPI assigned

May 9, 2007

Last updated

Aug 31, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Matt Domico LCSW LLC

  • Adult Mental Health Clinic/Center
  • Peoria, IL
  • NPI 1962294629
  NPD
• Suburban Psychiatry and Counseling Center LTD.

  • Exclusive Provider Organization
  • Willowbrook, IL
  • NPI 1275722613
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756598400000",
    "number": "1790999191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 N PROSPECT RD STE 105",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144358",
            "telephone_number": "815-701-6317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 E WAR MEMORIAL DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616167548",
            "telephone_number": "815-701-6317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMICO",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2025-08-31",
        "certification_date": "2025-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149013431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dolan Central Illinois Compounding Pharmacy LLC
• Shannon Dolan
• Tonia Dolan
• Pamela Doloszycki, APN
• Cassidy Louise Domagalla
• Miranda Dominguez
• Sarah E Dominique, APN CDE
• Jerome Taymon Domzalski, MD
• Janine E. Donahue, M.D.
• Kathleen Donahue

• Clinical Social Worker in Peoria, IL
• Providers in Peoria, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.