Matt Domico LCSW LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

MATT DOMICO LCSW LLC

Practice address

5901 N Prospect Rd Ste 105
Peoria, IL 61614-4358

Phone

(815) 701-6317

NPI assigned

May 20, 2025

Organization subpart

No

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

Authorized official

Name

Matt Domico, LCSW

Title

Ceo

Phone

(815) 701-6317

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew David Domico, MSW, LCSW

  • Clinical Social Worker
  • Peoria, IL
  • NPI 1790999191
  NPD

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

{
    "created_epoch": "1747699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1962294629",
    "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": "5901 N PROSPECT RD STE 105",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144358",
            "telephone_number": "815-701-6317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATT DOMICO LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-20",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A",
        "authorized_official_last_name": "DOMICO",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "815-701-6317",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine A Mathus, PTA
• Payam Matin
• Gabor Matos, M.D.
• Asma Matougelwerfelli, MD
• Andrew Matson, PT, DPT
• Shanta D. Mattai
• Stephen J Mattern, MA LCPC
• Evelyn Matthews
• Paul M Matthews, M.D.
• Katherine Every Matulle, DO

• Adult Mental Health Clinic/Center in Peoria, IL
• Providers in Peoria, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.