MATT DOMICO LCSW LLC NPI 1962294629

NPI Information

  • NPI: 1962294629
  • Provider Name: MATT DOMICO LCSW LLC
  • Classification: Clinic/Center - 261QM0850X
  • Specialization: Adult Mental Health
  • Entity Type: Organization
  • Address: 5901 N PROSPECT RD STE 105
    PEORIA, IL
    ZIP 61614
  • Phone: (815) 701-6317

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NPI Details

MATT DOMICO LCSW LLC is an adult mental health clinic center in Peoria, IL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. MATT DOMICO LCSW LLC NPI is 1962294629. The provider is registered as an organization entity type.

The provider's business location address is:

5901 N PROSPECT RD STE 105
PEORIA, IL
ZIP 61614-358
Phone: (815) 701-6317

The provider's authorized official is Matt Domico .
The authorized official title is Ceo and has the following contact phone number (815) 701-6317.

The enumeration date for this NPI number is 5/20/2025 and was last updated on 5/20/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0850XClinic/CenterAdult Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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