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MATT DOMICO LCSW LLC
NPI 1962294629
Clinic/Center - Adult Mental Health in Peoria, IL

Active since May 20, 2025
5901 N PROSPECT RD STE 105, PEORIA, IL 61614(815) 701-6317 Get Directions Write a Review

NPPES record last updated: May 20, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Matt Domico Lcsw Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MATT DOMICO LCSW LLC (NPI 1962294629) is a healthcare organization registered as an adult mental health in Peoria, Illinois and active in the NPI registry since May 2025. The organization lists Matt Domico, Ceo, as its authorized official.

NPPES Registry Identity

NPI1962294629
Entity TypeOrganization
Primary Taxonomy261QM0850X
Legal Business NameMATT DOMICO LCSW LLC
Location Address5901 N PROSPECT RD STE 105Peoria, IL 61614-4358
Mailing Address5901 N Prospect Rd Ste 105Peoria, IL 61614-4358 · (815) 701-6317
Phone(815) 701-6317
Organization SubpartNo
Authorized OfficialMatt DomicoCeo · (815) 701-6317
Enumeration DateMay 20, 2025
NPPES CertifiedMay 20, 2025
✔ NPI 1962294629 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Adult Mental HealthAmbulatory Health Care Facilities
Taxonomy Code261QM0850X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
5901 N PROSPECT RD STE 105, Peoria, IL 61614
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Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NICOLE D BURK LCSW
Social Worker (Clinical)
5901 N PROSPECT RD STE 105
PEORIA, IL 61614
Peoria County (309) 363-1563
AMANDA BREEDEN COUNSELING SERVICES LLC
Counselor (Mental Health)
5901 N PROSPECT RD STE 105
PEORIA, IL 61614
Peoria County (309) 340-1363
AMANDA BREEDEN LCPC
Counselor (Mental Health)
5901 N PROSPECT RD STE 105
PEORIA, IL 61614
Peoria County (309) 340-1363

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Matt Domico Lcsw LLC's NPI number?

The NPI number for Matt Domico Lcsw LLC is 1962294629. It was assigned to this organization in the NPPES registry on May 20, 2025.

Where is Matt Domico Lcsw LLC located?

Matt Domico Lcsw LLC is located at 5901 N Prospect Rd Ste 105, Peoria, IL 61614. The listed phone number is (815) 701-6317.

What is Matt Domico Lcsw LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adult Mental Health, with taxonomy code 261QM0850X.

When was this NPI record last updated?

The NPPES record for Matt Domico Lcsw LLC was last updated on May 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.