Organization
MATT DOMICO LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT DOMICO LCSW (CEO)
(815) 701-6317
Entity
Organization
Contact information
Practice address
5901 N PROSPECT RD STE 105, PEORIA, IL 61614-4358
(815) 701-6317
Mailing address
5901 N PROSPECT RD STE 105, PEORIA, IL 61614-4358
(815) 701-6317
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
05/20/2025
Last updated
05/20/2025
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